Provider Demographics
NPI:1780739581
Name:MORISSEAU, PHILIPPE (DMD)
Entity type:Individual
Prefix:
First Name:PHILIPPE
Middle Name:
Last Name:MORISSEAU
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 1:360 POTTER RD
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-1646
Mailing Address - Country:US
Mailing Address - Phone:401-884-1243
Mailing Address - Fax:
Practice Address - Street 1:1051 TEN ROD RD
Practice Address - Street 2:UNIT 5
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-4163
Practice Address - Country:US
Practice Address - Phone:401-295-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI22701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI2270OtherLICENSE NUMBER