Provider Demographics
NPI:1144112558
Name:WICKED GOOD DENTAL PLLC
Entity type:Organization
Organization Name:WICKED GOOD DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:TUBO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-377-2525
Mailing Address - Street 1:1 LAMBERT LIND HWY STE C
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1160
Mailing Address - Country:US
Mailing Address - Phone:774-280-2704
Mailing Address - Fax:
Practice Address - Street 1:1 LAMBERT LIND HWY STE C
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1160
Practice Address - Country:US
Practice Address - Phone:774-280-2704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty