| Name: | Periodontics, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 02 Jan 1969 (56 years ago) |
| Identification Number: | 000010073 |
| ZIP code: | 02906 |
| County: | Providence County |
| Principal Address: | 167 GANO STREET, PROVIDENCE, RI, 02906, USA |
| Purpose: | PERIODONTAL PRACTICE |
| NAICS: | 621210 - Offices of Dentists |
| Historical names: |
Periodontal Associates, Inc. Drs. Paul L. Segal and Daniel P. DeCesare, Inc. |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1841398658 | 2006-09-20 | 2020-08-22 | 167 GANO STREET, PROVIDENCE, RI, 02906, US | 167 GANO STREET, PROVIDENCE, RI, 02906, US | |||||||||||||||||||||||||||||||||||
|
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| Phone | +1 401-274-2600 |
| Fax | 4014217875 |
Authorized person
| Name | DR. SCOTT M FERTIK |
| Role | PRESIDENT |
| Phone | 4012742600 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| License Number | DEN02345 |
| State | RI |
| Is Primary | Yes |
| Taxonomy Code | 122300000X - Dentist |
| License Number | DEN02700 |
| State | RI |
| Is Primary | No |
| Taxonomy Code | 122300000X - Dentist |
| License Number | DEN01328 |
| State | RI |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| E. COLBY CAMERON, ESQ. | Agent | 301 PROMENADE STREET, PROVIDENCE, RI, 02908, USA |
| Name | Role | Address |
|---|---|---|
| SCOTT M. FERTIK, DDS | PRESIDENT | 167 GANO STREET PROVIDENCE, RI 02906 USA |
| Name | Role | Address |
|---|---|---|
| JOHN G. BRODERICK DMD | VICE PRESIDENT | 167 GANO STREET PROVIDENCE, RI 02906 USA |
| Name | Role | Address |
|---|---|---|
| SCOTT M. FERTIK DDS | DIRECTOR | 167 GANO STREET PROVIDENCE, RI 02906 USA |
| JOHN G. BRODERICK DMD | DIRECTOR | 167 GANO STREET PROVIDENCE, RI 02906 USA |
| Type | Date | Old Value | New Value |
|---|---|---|---|
| Name Change | 1995-01-09 | Drs. Paul L. Segal and Daniel P. DeCesare, Inc. | Periodontics, Inc. |
| Name Change | 1971-01-25 | Periodontal Associates, Inc. | Drs. Paul L. Segal and Daniel P. DeCesare, Inc. |
| Number | Name | File Date |
|---|---|---|
| 202448882600 | Annual Report | 2024-03-19 |
| 202333230310 | Annual Report | 2023-04-18 |
| 202216986770 | Annual Report | 2022-05-06 |
| 202191256820 | Annual Report | 2021-02-10 |
| 202035448680 | Annual Report | 2020-02-25 |
| 201986617660 | Annual Report | 2019-02-13 |
| 201857745010 | Annual Report | 2018-02-05 |
| 201731367800 | Annual Report | 2017-02-02 |
| 201691899980 | Annual Report | 2016-02-04 |
| 201556984170 | Annual Report | 2015-03-11 |
Date of last update: 05 Oct 2024
Sources: Rhode Island Department of State
