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Organization
NORTHWEST DENTAL
Active
Organization
NORTHWEST DENTAL
Active
Parent organization
NORTHWEST COMMUNITY HEALTH CARE
Other names
WellOne Primary Medical and Dental Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
NORTHWEST COMMUNITY HEALTH CARE
Authorized official
MR. PETER BANCROFT (CEO)
(401) 568-7661
Entity
Organization
Contact information
Practice address
36 BRIDGE WAY, PASCOAG, RI 02859-3312
(401) 568-7661
(401) 567-0900
Mailing address
36 BRIDGE WAY, PO BOX 312, PASCOAG, RI 02859-3131
(401) 568-7661
(401) 567-0900
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
ACF01571
RI
261QD0000X
Dental Clinic/Center
Primary
ACF01571
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NW44528
—
RI
Enumeration date
03/17/2008
Last updated
06/01/2012
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