Provider Demographics
NPI:1982148243
Name:JOHNSTON DENTAL GROUP, LLC
Entity Type:Organization
Organization Name:JOHNSTON DENTAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPALBO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:401-273-4411
Mailing Address - Street 1:1524 ATWOOD AVE
Mailing Address - Street 2:SUITE 438
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-3228
Mailing Address - Country:US
Mailing Address - Phone:401-273-4411
Mailing Address - Fax:
Practice Address - Street 1:1524 ATWOOD AVE
Practice Address - Street 2:SUITE 438
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-3228
Practice Address - Country:US
Practice Address - Phone:401-273-4411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty