Individual
DEREK NOBREGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
21 PEACE ST, PROVIDENCE, RI 02907-1510
(401) 456-4461
(401) 456-4420
Mailing address
825 CHALKSTONE AVE, N. CAMPUS BUSINESS OFFICE, ATTN: R. SOARES, PROVIDENCE, RI 02908-4728
(401) 456-2525
(401) 456-6742
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
LD00081
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LD00081
LICENSE
RI
Enumeration date
07/11/2012
Last updated
07/11/2012
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