Organization
PERIODONTICS INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SCOTT M FERTIK DDS (PRESIDENT)
(401) 274-2600
Entity
Organization
Contact information
Practice address
167 GANO STREET, PROVIDENCE, RI 02906
(401) 274-2600
(401) 421-7875
Mailing address
167 GANO STREET, PROVIDENCE, RI 02906
(401) 274-2600
(401) 421-7875
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DEN01328
RI
122300000X
Dentist
Primary
DEN02345
RI
122300000X
Dentist
DEN02700
RI
Other
Enumeration date
09/20/2006
Last updated
08/22/2020
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