Provider Demographics
NPI:1952683286
Name:DR JOHN RICCI
Entity Type:Organization
Organization Name:DR JOHN RICCI
Other - Org Name:PRIMEAU DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:RICCI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:401-737-9363
Mailing Address - Street 1:200 TOLL GATE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4491
Mailing Address - Country:US
Mailing Address - Phone:401-737-9363
Mailing Address - Fax:
Practice Address - Street 1:200 TOLL GATE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4491
Practice Address - Country:US
Practice Address - Phone:401-737-9363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIJR00816Medicaid