Provider Demographics
NPI:1659188761
Name:WEST SIDE DENTAL PLLC
Entity type:Organization
Organization Name:WEST SIDE DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPALBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-741-7395
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:401-372-5111
Mailing Address - Fax:
Practice Address - Street 1:650 CHASE PKWY
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3046
Practice Address - Country:US
Practice Address - Phone:203-597-8878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental