Provider Demographics
NPI:1366441388
Name:DEQUATTRO, FRANK ALBERT (DMD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:ALBERT
Last Name:DEQUATTRO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 SALT POND RD
Mailing Address - Street 2:SUITE C1
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-4314
Mailing Address - Country:US
Mailing Address - Phone:401-783-9890
Mailing Address - Fax:
Practice Address - Street 1:24 SALT POND RD
Practice Address - Street 2:SUITE C1
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-4314
Practice Address - Country:US
Practice Address - Phone:401-783-9890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
RI27111223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA175316OtherUNITED CONCORDIA
RI8770-2OtherBLUE CROSS BLUE SHIELD RI
RIFD35850Medicaid