Provider Demographics
NPI:1306859749
Name:TURCHETTA, BRAD JOHN
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:JOHN
Last Name:TURCHETTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1865 POST RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1547
Mailing Address - Country:US
Mailing Address - Phone:401-739-5252
Mailing Address - Fax:401-739-2064
Practice Address - Street 1:1865 POST RD
Practice Address - Street 2:SUITE 204
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1547
Practice Address - Country:US
Practice Address - Phone:401-739-5252
Practice Address - Fax:401-739-2064
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI26421223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1863667OtherUNITED CONCORDIA PROVIDER
RI8434-5OtherBLUE CROSS PROVIDER NUMBE