Healthcare Provider Details

I. General information

NPI: 1558937235
Provider Name (Legal Business Name): CHILDRENS' DENTISTRY OF RI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 GRANITE ST
WESTERLY RI
02891-2495
US

IV. Provider business mailing address

29 UPDIKE AVE
NORTH KINGSTOWN RI
02852-5728
US

V. Phone/Fax

Practice location:
  • Phone: 401-596-8720
  • Fax:
Mailing address:
  • Phone:
  • 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: DR. MICHAEL CAPALBO
Title or Position: CHIEF DENTIST
Credential: DO
Phone: 401-741-7395