Provider Demographics
NPI:1114680220
Name:CHILDRENS DENTISTRY OF RI LLC
Entity Type:Organization
Organization Name:CHILDRENS DENTISTRY OF RI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF DENSTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPALBO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:401-742-0581
Mailing Address - Street 1:29 UPDIKE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-5728
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:130 GRANITE ST STE C
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2461
Practice Address - Country:US
Practice Address - Phone:401-596-8720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental