Healthcare Provider Details

I. General information

NPI: 1801130208
Provider Name (Legal Business Name): CAPALBO DENTAL GROUP OF WICKFORD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2012
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 UPDIKE AVE
NORTH KINGSTOWN RI
02852-5728
US

IV. Provider business mailing address

29 UPDIKE AVE
NORTH KINGSTOWN RI
02852-5728
US

V. Phone/Fax

Practice location:
  • Phone: 401-295-1992
  • Fax: 401-295-5854
Mailing address:
  • Phone: 401-295-1992
  • Fax: 401-295-5854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateRI

VIII. Authorized Official

Name: DR. MICHAEL CAPALBO
Title or Position: OWNER
Credential: DMD
Phone: 401-295-1992