Healthcare Provider Details

I. General information

NPI: 1982148243
Provider Name (Legal Business Name): JOHNSTON DENTAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2016
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1526 ATWOOD AVE STE 102
JOHNSTON RI
02919-3289
US

IV. Provider business mailing address

29 UPDIKE AVE
N KINGSTOWN RI
02852-5728
US

V. Phone/Fax

Practice location:
  • Phone: 401-273-4411
  • Fax:
Mailing address:
  • Phone: 401-414-5380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL CAPABLO
Title or Position: OWNER/ CHIEF DENTIST
Credential: DMD
Phone: 401-741-7395