Organization
DUTCHMEN DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JON PAUL VAN REGENMORTER D.D.S. (OWNER)
(401) 624-9177
Entity
Organization
Contact information
Practice address
1359 MAIN RD, TIVERTON, RI 02878-4426
(401) 624-9177
(401) 624-9233
Mailing address
1359 MAIN RD, TIVERTON, RI 02878-4426
(401) 624-9177
(401) 624-9233
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DEN02748
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0281077
—
MA
01
—
8094-5
BLUE CROSS BLUE SHIELD OF RI
RI
05
—
9197544
—
MA
01
—
X12325
BLUE CROSS BLUE SHIELD OF MA
MA
Enumeration date
04/29/2008
Last updated
04/29/2008
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