# NORTHWEST DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** NORTHWEST COMMUNITY HEALTH CARE
- **Other names:** WellOne Primary Medical and Dental Care
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1588835623
- **Legal business name:** NORTHWEST COMMUNITY HEALTH CARE
- **Authorized official:** MR. PETER BANCROFT (CEO)
- **Authorized official phone:** (401) 568-7661

## Contact information

- **Practice address:** 36 BRIDGE WAY, PASCOAG, RI 02859-3312
- **Practice address phone:** (401) 568-7661
- **Practice address fax:** (401) 567-0900
- **Mailing address:** 36 BRIDGE WAY, PO BOX 312, PASCOAG, RI 02859-3131
- **Mailing address phone:** (401) 568-7661
- **Mailing address fax:** (401) 567-0900

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | ACF01571 | RI | — |
| 261QD0000X | Dental Clinic/Center | ACF01571 | RI | Yes |

## Other

- **Enumeration date:** 03/17/2008
- **Last updated:** 06/01/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | NW44528 | — | RI |