Provider Demographics
NPI:1134689128
Name:JEFFERSON DENTAL ASSOCIATES II, LLC
Entity Type:Organization
Organization Name:JEFFERSON DENTAL ASSOCIATES II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPABLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-741-7395
Mailing Address - Street 1:222 JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-3847
Mailing Address - Country:US
Mailing Address - Phone:401-739-2350
Mailing Address - Fax:
Practice Address - Street 1:222 JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-3847
Practice Address - Country:US
Practice Address - Phone:401-739-2350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental