NPIMap

Organization Active NPI

Coventry Orthodontic LLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Coventry, RI
National Provider Identifier
1124263884
Registry record updated Dec 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
1716 Issued in RI
Legal business name
COVENTRY ORTHODONTIC LLC
Practice address
2435 Nooseneck Hill Rd
Coventry, RI 02816
Phone
(401) 397-9400
Fax
(401) 397-9402
NPI assigned
Dec 10, 2008
Last updated
Dec 10, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2008

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

Authorized official

Name
Dr. John S Kacewicz
Title
Orthodontist
Phone
(401) 884-6500

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X 2642 RI
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X 3001 RI
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X 1716 RI Primary

Addresses

Primary practice location

2435 Nooseneck Hill Rd
Coventry, RI 02816

Mailing address

2435 Nooseneck Hill Rd
Coventry, RI 02816
Phone (401) 397-9400

Other names 1

  • Rhode Island Orthodontic Group Other name

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1228867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228867200000",
    "number": "1124263884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2435 NOOSENECK HILL RD",
            "city": "COVENTRY",
            "state": "RI",
            "postal_code": "02816",
            "telephone_number": "401-397-9400",
            "fax_number": "401-397-9402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2435 NOOSENECK HILL RD",
            "city": "COVENTRY",
            "state": "RI",
            "postal_code": "02816",
            "telephone_number": "401-397-9400",
            "fax_number": "401-397-9402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENTRY ORTHODONTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-10",
        "last_updated": "2008-12-10",
        "status": "A",
        "authorized_official_last_name": "KACEWICZ",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "ORTHODONTIST",
        "authorized_official_telephone_number": "401-884-6500",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "RI",
            "license": "2642",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "RI",
            "license": "3001",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "RI",
            "license": "1716",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rhode Island Orthodontic Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Coventry, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2008; 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.