Provider Demographics
NPI:1336548130
Name:SOUTH COUNTY PEDIATRIC DENTISTRY, LLC
Entity Type:Organization
Organization Name:SOUTH COUNTY PEDIATRIC DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:WESTCOTT
Authorized Official - Last Name:DOWNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:401-789-7200
Mailing Address - Street 1:6 LAMBERT STREET
Mailing Address - Street 2:
Mailing Address - City:NARRAGANSETT
Mailing Address - State:RI
Mailing Address - Zip Code:02882-3399
Mailing Address - Country:US
Mailing Address - Phone:401-789-7200
Mailing Address - Fax:401-789-7205
Practice Address - Street 1:6 LAMBERT STREET
Practice Address - Street 2:
Practice Address - City:NARRAGANSETT
Practice Address - State:RI
Practice Address - Zip Code:02882-3399
Practice Address - Country:US
Practice Address - Phone:401-789-7200
Practice Address - Fax:401-789-7205
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:M DOWNEY REAL ESTATE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-18
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN031161223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIMD85555Medicaid