Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DEN01328 | RI |
NPI | 1124231253 |
---|---|
Provider Name | Dr. Daniel Peter Decesare |
First Address | Johnston, RI 02919-3269 |
Second Address | Johnston, RI 02919-3269 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 08/07/2009 |