Provider Demographics
NPI:1477643674
Name:DEVINE, JAMES EDWARD III (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDWARD
Last Name:DEVINE
Suffix:III
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 1:63 EDDIE DOWLING HWY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:NORTH SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02896-7322
Mailing Address - Country:US
Mailing Address - Phone:401-765-5511
Mailing Address - Fax:
Practice Address - Street 1:63 EDDIE DOWLING HWY
Practice Address - Street 2:SUITE 5
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896-7322
Practice Address - Country:US
Practice Address - Phone:401-765-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI024361223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI000000012411-EPOtherUHP
RI000000012412OtherUHP
MA0412436OtherDELTA DENTAL OF MA
RIJD05234Medicaid
MAX06296-WOONOtherBLUE CROSS OF MA
RI1002436/2002436OtherDELTA DENTAL
RI8519-1OtherBC
MAV04129-EPOtherBLUE CROSS OF MA