Individual
SAMUEL R. ZWETCHKENBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
56 WOODBURY ST, PROVIDENCE, RI 02906-3510
(401) 588-1295
Mailing address
375 ALLENS AVE, PROVIDENCE, RI 02905-5010
(401) 780-2511
(401) 780-2565
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
22DI01757400
NJ
122300000X
Dentist
2901016737
MI
122300000X
Dentist
Primary
DEN02285
RI
1223P0700X
Prosthodontics
22DI01757400
NJ
1223P0700X
Prosthodontics
2901016737
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00-D-16-7370-0
BCBSM
MI
05
—
4124463
—
MI
05
—
4124472
—
MI
Enumeration date
10/27/2006
Last updated
10/08/2025
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