Organization
RHODE ISLAND CHILDRENS DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM GORDON DMD (OWNER)
(401) 828-1171
Entity
Organization
Contact information
Practice address
840 TIOGUE AVE, COVENTRY, RI 02816-5914
(401) 828-1171
Mailing address
840 TIOGUE AVE, COVENTRY, RI 02816-5914
(401) 828-1171
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
1223P0221X
Pediatric Dentistry
DEN03331
RI
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
RI2421
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1073900338
NPI
RI
01
—
1730152182
NPI
RI
Enumeration date
05/31/2017
Last updated
07/21/2022
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