NPIMap

Organization Active NPI

Distinctive Dentistry

  • Dentist
  • Greenville, RI
National Provider Identifier
1063649549
Registry record updated May 26, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
DISTINCTIVE DENTISTRY
Practice address
595 Putnam Pike
Greenville, RI 02828-2137
Phone
(401) 949-1420
Fax
(401) 949-5494
NPI assigned
Jun 11, 2009
Last updated
May 26, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Derek E Hathaway, DMDNPI 1417911330
Title
President
Phone
(401) 949-1420

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU Primary

Addresses

Primary practice location

595 Putnam Pike
Greenville, RI 02828-2137

Mailing address

595 Putnam Pike
Greenville, RI 02828-2137

Other identifiers 1

IdentifierTypeStateIssuer
DI83209MedicaidRI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1244678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306368000000",
    "number": "1063649549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "595 PUTNAM PIKE",
            "city": "GREENVILLE",
            "state": "RI",
            "postal_code": "028282137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "595 PUTNAM PIKE",
            "city": "GREENVILLE",
            "state": "RI",
            "postal_code": "028282137",
            "telephone_number": "401-949-1420",
            "fax_number": "401-949-5494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DISTINCTIVE DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-11",
        "last_updated": "2011-05-26",
        "status": "A",
        "authorized_official_last_name": "HATHAWAY",
        "authorized_official_first_name": "DEREK",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "401-949-1420",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DI83209",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.