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General NPI Number Information
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NPI Number | 1699063099
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Entity Type | Organization
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Legal Business Name | DENTAL GROUP OF WAKEFIELD LLC
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Dates
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Enumeration Date | 07/19/2011
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Last Update Date | 07/20/2011
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Provider Practice Location Address
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Address Line | 26 SOUTH COUNTY COMMONS DENTAL GROUP OF WAKEFIELD LLC
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City | WAKEFIELD
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State | RI
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Zip | 02880
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Country | US
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Telephone | 401-789-9718
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Fax |
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Provider Business Mailing Address
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Address Line | 26 SOUTH COUNTY COMMONS WAY DENTAL GROUP OF WAKEFIELD LLC
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City | WAKEFIELD
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State | RI
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Zip | 02880
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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 | OWNER
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Name | MATTHEW BRIAN CAPALBO
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Credential | DMD
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Telephone | 401-789-9718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2981
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2931
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License Number State | RI
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