Provider Demographics
NPI:1649488354
Name:OCCASO, DONALD LOUIS (DMD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:LOUIS
Last Name:OCCASO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-2635
Mailing Address - Country:US
Mailing Address - Phone:401-846-4800
Mailing Address - Fax:401-846-4800
Practice Address - Street 1:292 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-2635
Practice Address - Country:US
Practice Address - Phone:401-846-4800
Practice Address - Fax:401-846-4800
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI1701122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist