Organization
WICKFORD ORTHODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLEY RADTKE (OFFICE MANAGER)
(401) 295-2700
Entity
Organization
Contact information
Practice address
320 PHILLIPS ST, SUITE 202, NORTH KINGSTOWN, RI 02852-5149
(401) 295-2700
Mailing address
320 PHILLIPS ST, SUITE 202, NORTH KINGSTOWN, RI 02852-5149
(401) 295-2700
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
RI002894
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SW60095
—
RI
05
—
WO60094
—
RI
Enumeration date
06/05/2007
Last updated
08/22/2020
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