| Wellone Primary Medical And Dental Care | |
|
36 Bridge Way Pascoag RI 02859-3312 | |
| (401) 568-7661 | |
| (401) 567-0900 |
| Full Name | Wellone Primary Medical And Dental Care |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 36 Bridge Way, Pascoag, Rhode Island |
| Authorized Official Name and Position | Peter Bancroft (CEO) |
| Authorized Official Contact | 4015687661 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wellone Primary Medical And Dental Care 36 Bridge Way Po Box 312 Pascoag RI 02859-3131 Ph: (401) 568-7661 | Wellone Primary Medical And Dental Care 36 Bridge Way Pascoag RI 02859-3312 Ph: (401) 568-7661 |
| NPI Number | 1588835623 |
|---|---|
| Provider Enumeration Date | 03/17/2008 |
| Last Update Date | 06/01/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588835623 | NPI | - | NPPES |
| NW44528 | Medicaid | RI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | ACF01571 (Rhode Island) | Secondary |
| 261QD0000X | Clinic/center - Dental | ACF01571 (Rhode Island) | Primary |
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