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General NPI Number Information
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NPI Number | 1114680220
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Entity Type | Organization
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Legal Business Name | CHILDRENS DENTISTRY OF RI LLC
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Dates
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Enumeration Date | 10/15/2021
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Last Update Date | 10/15/2021
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Provider Practice Location Address
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Address Line | 130 GRANITE ST STE C
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City | WESTERLY
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State | RI
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Zip | 02891-2461
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Country | US
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Telephone | 401-596-8720
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Fax |
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Provider Business Mailing Address
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Address Line | 29 UPDIKE AVE
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City | NORTH KINGSTOWN
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State | RI
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Zip | 02852-5728
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF DENSTIST
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Name | DR. MICHAEL CAPALBO
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Credential | DO
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Telephone | 401-742-0581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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