MEDICARE: THOMASTON DENTAL ASSOCIATES PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1548078710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMASTON DENTAL ASSOCIATES PLLC

Provider Business Mailing Address
First Line	:	29 UPDIKE AVE
Second Line	:
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852-5728
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 MARINE ST STE 6
Second Line	:
City	:	THOMASTON
State	:	CT
Zip	:	06787-1470
Country	:	US
Telephone Number	:	860-283-5770
Fax Number	:

Authorized Official
Title or Position	:	CHIEF DENTIST
Name	:	DR. MICHAEL CAPALBO
Credential	:	DO
Telephone Number	:	401-741-7395

Provider Enumeration Date	:	12/20/2024
Last Update Date	:	12/20/2024

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