Provider Demographics
NPI:1659724896
Name:'THAMES RIVER DENTAL GROUP
Entity Type:Organization
Organization Name:'THAMES RIVER DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPALBO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-447-1714
Mailing Address - Street 1:27 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-5973
Mailing Address - Country:US
Mailing Address - Phone:860-447-1714
Mailing Address - Fax:860-447-0363
Practice Address - Street 1:27 BROAD ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320
Practice Address - Country:US
Practice Address - Phone:860-447-1714
Practice Address - Fax:860-447-0363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11604122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty