Provider Demographics
NPI:1689726762
Name:DUPONT, GEORGE JOSEPH III (DDS)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:JOSEPH
Last Name:DUPONT
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 EDDY STREET
Mailing Address - Street 2:JOSEPH SAMUELS DENTAL CENTER AT RIH
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903
Mailing Address - Country:US
Mailing Address - Phone:401-444-8302
Mailing Address - Fax:401-444-3494
Practice Address - Street 1:593 EDDY STREET
Practice Address - Street 2:JOSEPH SAMUELS DENTAL CENTER AT RIH
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903
Practice Address - Country:US
Practice Address - Phone:401-444-8302
Practice Address - Fax:401-444-3494
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN025241223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIDP13793Medicaid