NPIMap

Organization Active NPI

Dutchmen Dental LLC

  • General Practice Dentistry
  • Tiverton, RI
National Provider Identifier
1912172016
Registry record updated Apr 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DEN02748 Issued in RI
Legal business name
DUTCHMEN DENTAL LLC
Practice address
1359 Main Rd
Tiverton, RI 02878-4426
Phone
(401) 624-9177
Fax
(401) 624-9233
NPI assigned
Apr 29, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2008

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

Authorized official

Name
Mr. Jon Paul Van Regenmorter, D.D.S.NPI 1396841797
Title
Owner
Phone
(401) 624-9177

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
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X DEN02748 RI Primary

Addresses

Primary practice location

1359 Main Rd
Tiverton, RI 02878-4426

Mailing address

1359 Main Rd
Tiverton, RI 02878-4426
Phone (401) 624-9177

Other identifiers 4

IdentifierTypeStateIssuer
8094-5OtherRIBLUE CROSS BLUE SHIELD OF RI
X12325OtherMABLUE CROSS BLUE SHIELD OF MA
0281077MedicaidMA
9197544MedicaidMA

National Provider Directory

National Provider Directory
Tax ID family
Dutchmen Dental LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1209427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209427200000",
    "number": "1912172016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1359 MAIN RD",
            "city": "TIVERTON",
            "state": "RI",
            "postal_code": "028784426",
            "telephone_number": "401-624-9177",
            "fax_number": "401-624-9233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1359 MAIN RD",
            "city": "TIVERTON",
            "state": "RI",
            "postal_code": "028784426",
            "telephone_number": "401-624-9177",
            "fax_number": "401-624-9233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DUTCHMEN DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-29",
        "last_updated": "2008-04-29",
        "status": "A",
        "authorized_official_last_name": "VAN REGENMORTER",
        "authorized_official_first_name": "JON PAUL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "401-624-9177",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "RI",
            "license": "DEN02748",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF RI",
            "identifier": "8094-5",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF MA",
            "identifier": "X12325",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0281077",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9197544",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tiverton, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 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.