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General NPI Number Information
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NPI Number | 1982148243
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Entity Type | Organization
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Legal Business Name | JOHNSTON DENTAL GROUP, LLC
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Dates
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Enumeration Date | 12/06/2016
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Last Update Date | 12/06/2016
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Provider Practice Location Address
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Address Line | 1524 ATWOOD AVE SUITE 438
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City | JOHNSTON
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State | RI
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Zip | 02919-3228
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Country | US
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Telephone | 401-273-4411
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Fax |
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Provider Business Mailing Address
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Address Line | 1524 ATWOOD AVE SUITE 438
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City | JOHNSTON
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State | RI
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Zip | 02919-3228
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Country | US
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Telephone | 401-273-4411
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. MARCUS CAPALBO
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Credential | D.M.D.
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Telephone | 401-273-4411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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