Provider Demographics
NPI:1720222011
Name:CRESTVIEW DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:CRESTVIEW DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TORBETT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:401-596-0319
Mailing Address - Street 1:33 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-2907
Mailing Address - Country:US
Mailing Address - Phone:401-596-0319
Mailing Address - Fax:401-596-4448
Practice Address - Street 1:33 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2907
Practice Address - Country:US
Practice Address - Phone:401-596-0319
Practice Address - Fax:401-596-4448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI02949261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental