Provider Demographics
NPI:1417231572
Name:RI DENTAL CARE INC.
Entity Type:Organization
Organization Name:RI DENTAL CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTUBY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:401-729-9500
Mailing Address - Street 1:868 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5646
Mailing Address - Country:US
Mailing Address - Phone:401-729-9500
Mailing Address - Fax:401-729-9519
Practice Address - Street 1:868 CHARLES STRETE
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5646
Practice Address - Country:US
Practice Address - Phone:401-729-9500
Practice Address - Fax:401-729-9519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN18741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1346521200Medicaid
RI158695658Medicaid
RI1942323621Medicaid
RI1144473588Medicaid
RI1336478882Medicaid