Individual provider Active NPI

Eric J Prosseda, DMD

  • General Practice Dentistry
  • Wakefield, RI
National Provider Identifier
1124034228
Registry record updated Jun 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DEN02765 Issued in RI
Practice address
1 River St
Wakefield, RI 02879
Phone
(401) 783-0523
Fax
(401) 783-9448
NPI assigned
Jul 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DEN02765 RI Primary

Addresses

Primary practice location

1 River St
Wakefield, RI 02879

Mailing address

1 River St
Wakefield, RI 02879-3214
Phone (401) 783-5646

Other identifiers 1

IdentifierTypeStateIssuer
EP42524MedicaidRI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160309001313 RI Order and Referring Only - DentistPractitioner - Dentist 7416253992

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DEN02765RIMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750809600000",
    "number": "1124034228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 RIVER ST",
            "city": "WAKEFIELD",
            "state": "RI",
            "postal_code": "028793214",
            "telephone_number": "401-783-5646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 RIVER ST",
            "city": "WAKEFIELD",
            "state": "RI",
            "postal_code": "02879",
            "telephone_number": "401-783-0523",
            "fax_number": "401-783-9448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROSSEDA",
        "first_name": "ERIC",
        "middle_name": "J",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-31",
        "last_updated": "2025-06-25",
        "certification_date": "2025-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "RI",
            "license": "DEN02765",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "EP42524",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wakefield, RI

Sources for this page

Verify at the official NPI Registry.