NPI 1841403953 · live from the CMS NPI Registry
John G. Broderick, DMD
Dentist, Periodontics in Providence, RI. National Provider Identifier 1841403953, active.
NPI record
| NPI | 1841403953 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dentist, Periodontics 1223P0300X |
| Practice location | 167 Gano St, Providence, RI 02906 |
| Practice phone | 401-274-2600 |
| Mailing address | 200 Heroux Blvd Unit 507, Cumberland, RI 02864 |
| Enumerated | May 7, 2007 |
| Last updated | July 8, 2007 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist, Periodontics primary | 1223P0300X | DEN02700 (RI) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.