Provider Demographics
NPI:1528211711
Name:WARWICK FAMILY DENTAL GROUP, INC
Entity Type:Organization
Organization Name:WARWICK FAMILY DENTAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:PAQUETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:401-739-8337
Mailing Address - Street 1:819 GREENWICH AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1815
Mailing Address - Country:US
Mailing Address - Phone:401-739-8337
Mailing Address - Fax:401-732-3341
Practice Address - Street 1:819 GREENWICH AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1815
Practice Address - Country:US
Practice Address - Phone:401-739-8337
Practice Address - Fax:401-732-3341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI2172261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental