MEDICARE: DR. MATTHEW BRIAN CAPALBO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2981	RI

General Provider Information

NPI Number	:	1700086543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW BRIAN CAPALBO

Provider Business Mailing Address
First Line	:	130 GRANITE ST
Second Line	:
City	:	WESTERLY
State	:	RI
Zip	:	02891-2495
Country	:	US
Telephone Number	:	401-474-4034
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 GRANITE ST
Second Line	:
City	:	WESTERLY
State	:	RI
Zip	:	02891-2461
Country	:	US
Telephone Number	:	401-596-2848
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2007
Last Update Date	:	06/21/2013

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