Active NPI
Samuel R. Zwetchkenbaum, DDS
- Dentist
- Providence, RI
National Provider Identifier
1871679415
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DEN02285
- Practice address
- 56 Woodbury St
Providence, RI 02906-3510 - Phone
- (401) 588-1295
- NPI assigned
- Oct 27, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 22DI01757400 | NJ | |
| Dentist | 122300000X | 2901016737 | MI | |
| Dentist | 122300000X | 22DI01757400 | NJ | |
| Dentist | 122300000X | DEN02285 | RI | Primary |
| Prosthodontics | 1223P0700X | 2901016737 | MI |
Addresses
Primary practice location
56 Woodbury St
Providence, RI 02906-3510
Mailing address
375 Allens Ave
Providence, RI 02905-5010
Phone (401) 780-2511
Other practice location 1
335R Prairie Ave
Providence, RI 02905-2426
Phone (401) 444-0430
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00-D-16-7370-0 | Other | MI | BCBSM |
| 4124472 | Medicaid | MI | |
| 4124463 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DEN02285 | RI | MD | Dentist |
| 2901016737 | MI | MD | Prosthodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161907200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1759881600000",
"number": "1871679415",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "375 ALLENS AVE",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029055010",
"telephone_number": "401-780-2511",
"fax_number": "401-780-2565"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "56 WOODBURY ST",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029063510",
"telephone_number": "401-588-1295"
}
],
"practiceLocations": [
{
"address_1": "335R Prairie Ave",
"address_purpose": "LOCATION",
"city": "Providence",
"state": "RI",
"postal_code": "029052426",
"country_code": "US",
"telephone_number": "401-444-0430",
"fax_number": "401-444-0489",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ZWETCHKENBAUM",
"first_name": "SAMUEL",
"middle_name": "R.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-27",
"last_updated": "2025-10-08",
"certification_date": "2025-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "NJ",
"license": "22DI01757400",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2901016737",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NJ",
"license": "22DI01757400",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "RI",
"license": "DEN02285",
"primary": true
},
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "MI",
"license": "2901016737",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSM",
"identifier": "00-D-16-7370-0",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4124472",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4124463",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Providence, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.