Organization
DISTINCTIVE DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEREK E HATHAWAY DMD (PRESIDENT)
(401) 949-1420
Entity
Organization
Contact information
Practice address
595 PUTNAM PIKE, GREENVILLE, RI 02828-2137
(401) 949-1420
(401) 949-5494
Mailing address
595 PUTNAM PIKE, GREENVILLE, RI 02828-2137
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DI83209
—
RI
Enumeration date
06/11/2009
Last updated
05/26/2011
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