Provider Demographics
NPI:1609045491
Name:EDWARD T. FERRY, DDS INC
Entity type:Organization
Organization Name:EDWARD T. FERRY, DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:FERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:401-781-2900
Mailing Address - Street 1:599 PONTIAC AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-4709
Mailing Address - Country:US
Mailing Address - Phone:401-781-2900
Mailing Address - Fax:
Practice Address - Street 1:599 PONTIAC AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-4709
Practice Address - Country:US
Practice Address - Phone:401-781-2900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI13031223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIEF00785Medicaid