Provider Demographics
NPI:1801130208
Name:CAPALBO DENTAL GROUP OF WICKFORD, LLC
Entity type:Organization
Organization Name:CAPALBO DENTAL GROUP OF WICKFORD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPALBO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:401-295-1992
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:401-295-1992
Mailing Address - Fax:401-295-5854
Practice Address - Street 1:29 UPDIKE AVE
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-5728
Practice Address - Country:US
Practice Address - Phone:401-295-1992
Practice Address - Fax:401-295-5854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty