Individual
DR. SCOTT MARK FERTIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
167 GANO ST, PROVIDENCE, RI 02906-3808
(401) 274-2600
(401) 421-7875
Mailing address
55 SIGNAL RIDGE WAY, E GREENWICH, RI 02818-1649
(401) 886-7999
(401) 421-7875
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
DEN02345
RI
Other
Enumeration date
05/15/2007
Last updated
07/08/2007
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