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  5. WESTERLY DENTAL GROUP, INC.

WESTERLY DENTAL GROUP, INC.

Company Details

Name: WESTERLY DENTAL GROUP, INC.
Jurisdiction: Rhode Island
Entity type: Professional Service Corporation
Status: Activ
Date of Organization in Rhode Island: 01 Jun 1977 (48 years ago)
Identification Number: 000017290
ZIP code: 02891
County: Washington County
Principal Address: 130 GRANITE STREET, WESTERLY, RI, 02891, USA
Purpose: RENDERING PROFESSIONAL DENTAL SERVICES

Industry & Business Activity

NAICS

621210 Offices of Dentists

This industry comprises establishments of health practitioners having the degree of D.M.D. (Doctor of Dental Medicine), D.D.S. (Doctor of Dental Surgery), or D.D.Sc. (Doctor of Dental Science) primarily engaged in the independent practice of general or specialized dentistry or dental surgery. These practitioners operate private or group practices in their own offices (e.g., centers, clinics) or in the facilities of others, such as hospitals or HMO medical centers. They can provide either comprehensive preventive, cosmetic, or emergency care, or specialize in a single field of dentistry. Learn more at the U.S. Census Bureau

Companies doing Offices of dentists

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1801097472 2007-05-30 2007-07-16 130 GRANITE ST, WESTERLY, RI, 028912461, US 130 GRANITE ST, WESTERLY, RI, 028912461, US

Contacts
Phone +1 401-595-2848
Fax 4015962993

Authorized person
Name DR. BRIAN M CAPALBO
Role DENTIST
Phone 4013222848

Taxonomy
Taxonomy Code 122300000X - Dentist
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
WESTERLY DENTAL GROUP, INC. EMPLOYEES' 401(K) PROFIT SHARING PLAN 2018 050373200 2019-06-14 WESTERLY DENTAL GROUP, INC. 24
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1986-06-01
Business code 621210
Sponsor’s telephone number 4015962848
Plan sponsor’s address 130 GRANITE STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2019-06-13
Name of individual signing BRIAN CAPALBO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-06-13
Name of individual signing BRIAN CAPALBO
Valid signature Filed with authorized/valid electronic signature
WESTERLY DENTAL GROUP, INC. CASH BALANCE PLAN 2017 050373200 2018-07-12 WESTERLY DENTAL GROUP, INC. 20
File View Page
Three-digit plan number (PN) 004
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 4015962848
Plan sponsor’s address 130 GRANITE STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2018-07-12
Name of individual signing BRIAN CAPALBO
Valid signature Filed with authorized/valid electronic signature
WESTERLY DENTAL GROUP, INC. CASH BALANCE PLAN 2017 050373200 2018-07-12 WESTERLY DENTAL GROUP, INC. 20
File View Page
Three-digit plan number (PN) 004
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 4015962848
Plan sponsor’s address 130 GRANITE STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2018-07-12
Name of individual signing BRIAN CAPALBO
Valid signature Filed with authorized/valid electronic signature
WESTERLY DENTAL GROUP, INC. EMPLOYEES' 401(K) PROFIT SHARING PLAN 2017 050373200 2018-07-13 WESTERLY DENTAL GROUP, INC. 23
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1986-06-01
Business code 621210
Sponsor’s telephone number 4015962848
Plan sponsor’s address 130 GRANITE STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2018-07-12
Name of individual signing BRIAN CAPALBO
Valid signature Filed with authorized/valid electronic signature
WESTERLY DENTAL GROUP, INC. EMPLOYEES' 401(K) PROFIT SHARING PLAN 2016 050373200 2017-06-27 WESTERLY DENTAL GROUP, INC. 22
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1986-06-01
Business code 621210
Sponsor’s telephone number 4015962848
Plan sponsor’s address 130 GRANITE STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2017-06-05
Name of individual signing BRIAN CAPALBO
Valid signature Filed with authorized/valid electronic signature
WESTERLY DENTAL GROUP, INC. CASH BALANCE PLAN 2016 050373200 2017-06-06 WESTERLY DENTAL GROUP, INC. 20
File View Page
Three-digit plan number (PN) 004
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 4015962848
Plan sponsor’s address 130 GRANITE STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2017-06-05
Name of individual signing BRIAN CAPALBO
Valid signature Filed with authorized/valid electronic signature
WESTERLY DENTAL GROUP, INC. EMPLOYEES' 401(K) PROFIT SHARING PLAN 2015 050373200 2016-10-11 WESTERLY DENTAL GROUP, INC. 22
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1986-06-01
Business code 621210
Sponsor’s telephone number 4015962848
Plan sponsor’s address 130 GRANITE STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2016-10-11
Name of individual signing BRIAN CAPALBO
Valid signature Filed with authorized/valid electronic signature
WESTERLY DENTAL GROUP, INC. CASH BALANCE PLAN 2015 050373200 2016-10-11 WESTERLY DENTAL GROUP, INC. 21
File View Page
Three-digit plan number (PN) 004
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 4015962848
Plan sponsor’s address 130 GRANITE STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2016-10-11
Name of individual signing BRIAN CAPALBO
Valid signature Filed with authorized/valid electronic signature
WESTERLY DENTAL GROUP, INC. CASH BALANCE PLAN 2014 050373200 2015-07-16 WESTERLY DENTAL GROUP, INC. 19
File View Page
Three-digit plan number (PN) 004
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 4015962848
Plan sponsor’s address 130 GRANITE STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2015-07-16
Name of individual signing BRIAN CAPALBO
Valid signature Filed with authorized/valid electronic signature
WESTERLY DENTAL GROUP, INC. EMPLOYEES' 401(K) PROFIT SHARING PLAN 2014 050373200 2015-06-22 WESTERLY DENTAL GROUP, INC. 21
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1986-06-01
Business code 621210
Sponsor’s telephone number 4015962848
Plan sponsor’s address 130 GRANITE STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2015-06-18
Name of individual signing BRIAN CAPALBO
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/06/30/20140630095904P030001383461001.pdf
Three-digit plan number (PN) 004
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 4015962848
Plan sponsor’s address 130 GRANITE STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2014-06-26
Name of individual signing BRIAN CAPALBO
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/06/26/20140626133716P040060908007001.pdf
Three-digit plan number (PN) 003
Effective date of plan 1995-01-01
Business code 621210
Sponsor’s telephone number 4015962848
Plan sponsor’s address 130 GRANITE STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2014-06-26
Name of individual signing BRIAN CAPALBO
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/07/09/20130709092645P030289412947001.pdf
Three-digit plan number (PN) 004
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 4015962848
Plan sponsor’s address 130 GRANITE STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2013-07-09
Name of individual signing BRIAN CAPALBO
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/07/09/20130709091129P040295940451001.pdf
Three-digit plan number (PN) 003
Effective date of plan 1995-01-01
Business code 621210
Sponsor’s telephone number 4015962848
Plan sponsor’s address 130 GRANITE STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2013-07-09
Name of individual signing BRIAN CAPALBO
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/07/30/20120730132058P040018366002001.pdf
Three-digit plan number (PN) 003
Effective date of plan 1995-01-01
Business code 621210
Sponsor’s telephone number 4015962848
Plan sponsor’s address 130 GRANITE STREET, WESTERLY, RI, 02891

Plan administrator’s name and address
Administrator’s EIN 050373200
Plan administrator’s name WESTERLY DENTAL GROUP, INC.
Plan administrator’s address 130 GRANITE STREET, WESTERLY, RI, 02891
Administrator’s telephone number 4015962848

Signature of
Role Plan administrator
Date 2012-07-30
Name of individual signing BRIAN CAPALBO
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/07/31/20120731101113P040019682866001.pdf
Three-digit plan number (PN) 004
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 4015962848
Plan sponsor’s address 130 GRANITE STREET, WESTERLY, RI, 02891

Plan administrator’s name and address
Administrator’s EIN 050373200
Plan administrator’s name WESTERLY DENTAL GROUP, INC.
Plan administrator’s address 130 GRANITE STREET, WESTERLY, RI, 02891
Administrator’s telephone number 4015962848

Signature of
Role Plan administrator
Date 2012-07-31
Name of individual signing BRIAN CAPALBO
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/10/17/20111017102501P040154737729001.pdf
Three-digit plan number (PN) 003
Effective date of plan 1995-01-01
Business code 621210
Sponsor’s telephone number 4015962848
Plan sponsor’s address 130 GRANITE STREET, WESTERLY, RI, 02891

Plan administrator’s name and address
Administrator’s EIN 050373200
Plan administrator’s name WESTERLY DENTAL GROUP, INC.
Plan administrator’s address 130 GRANITE STREET, WESTERLY, RI, 02891
Administrator’s telephone number 4015962848

Signature of
Role Plan administrator
Date 2011-10-17
Name of individual signing BRIAN CAPALBO
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/10/07/20111007120738P030144179345001.pdf
Three-digit plan number (PN) 004
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 4015962848
Plan sponsor’s address 130 GRANITE STREET, WESTERLY, RI, 02891

Plan administrator’s name and address
Administrator’s EIN 050373200
Plan administrator’s name WESTERLY DENTAL GROUP, INC.
Plan administrator’s address 130 GRANITE STREET, WESTERLY, RI, 02891
Administrator’s telephone number 4015962848

Signature of
Role Plan administrator
Date 2011-09-27
Name of individual signing BRIAN CAPALBO
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/10/15/20101015035146P030010775362001.pdf
Three-digit plan number (PN) 004
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 4015962848
Plan sponsor’s address 130 GRANITE STREET, WESTERLY, RI, 02891

Plan administrator’s name and address
Administrator’s EIN 050373200
Plan administrator’s name WESTERLY DENTAL GROUP, INC.
Plan administrator’s address 130 GRANITE STREET, WESTERLY, RI, 02891
Administrator’s telephone number 4015962848

Signature of
Role Plan administrator
Date 2010-10-14
Name of individual signing BRIAN CAPALBO
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/10/11/20101011105855P040002488599001.pdf
Three-digit plan number (PN) 003
Effective date of plan 1995-01-01
Business code 621210
Sponsor’s telephone number 4015962848
Plan sponsor’s address 130 GRANITE STREET, WESTERLY, RI, 02891

Plan administrator’s name and address
Administrator’s EIN 050373200
Plan administrator’s name WESTERLY DENTAL GROUP, INC.
Plan administrator’s address 130 GRANITE STREET, WESTERLY, RI, 02891
Administrator’s telephone number 4015962848

Signature of
Role Plan administrator
Date 2010-10-11
Name of individual signing BRIAN CAPALBO
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
ANDREW H. DAVIS, JR. ESQ. Agent THE OWEN BUILDING 101 DYER STREET, PROVIDENCE, RI, 02903, USA

PRESIDENT

Name Role Address
MICHAEL B. CAPALBO PRESIDENT 7 SHORELINE DRIVE WESTERLY, RI 02891 USA

Filings

Number Name File Date
202448424080 Annual Report 2024-03-13
202327439820 Annual Report 2023-02-03
202105263470 Annual Report 2021-11-22
202192125260 Annual Report 2021-02-19
202192135520 Annual Report 2021-02-19
202192124830 Reinstatement 2021-02-19
202082818120 Revocation Certificate For Failure to File the Annual Report for the Year 2020-12-30
202054954780 Revocation Notice For Failure to File An Annual Report 2020-09-16
202034814530 Annual Report - Amended 2020-02-20
201912062320 Annual Report 2019-08-13

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
4034258503 2021-02-25 0165 PPS 130 Granite St Ste 300, Westerly, RI, 02891-2495
Loan Status Date 2022-02-10
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 220105
Loan Approval Amount (current) 220105
Undisbursed Amount 0
Franchise Name -
Lender Location ID 65777
Servicing Lender Name The Washington Trust Company of Westerly
Servicing Lender Address 23 Broad St, WESTERLY, RI, 02891-1879
Rural or Urban Indicator R
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address Westerly, WASHINGTON, RI, 02891-2495
Project Congressional District RI-02
Number of Employees 21
NAICS code 621210
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Corporation
Originating Lender ID 65777
Originating Lender Name The Washington Trust Company of Westerly
Originating Lender Address WESTERLY, RI
Gender Male Owned
Veteran Non-Veteran
Forgiveness Amount 221963.66
Forgiveness Paid Date 2022-01-03
5992607002 2020-04-06 0165 PPP 130 GRANITE ST, WESTERLY, RI, 02891-2458
Loan Status Date 2021-08-06
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 220104
Loan Approval Amount (current) 220104
Undisbursed Amount 0
Franchise Name -
Lender Location ID 65777
Servicing Lender Name The Washington Trust Company of Westerly
Servicing Lender Address 23 Broad St, WESTERLY, RI, 02891-1879
Rural or Urban Indicator R
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address WESTERLY, WASHINGTON, RI, 02891-2458
Project Congressional District RI-02
Number of Employees 21
NAICS code 621210
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Corporation
Originating Lender ID 65777
Originating Lender Name The Washington Trust Company of Westerly
Originating Lender Address WESTERLY, RI
Gender Male Owned
Veteran Non-Veteran
Forgiveness Amount 222775.82
Forgiveness Paid Date 2021-07-02

Related by officers

ANDREW H. DAVIS, JR. ESQ.

Bay Capital Incorporated R.A. SAVARESE CUSTOM BUILDERS, INC. Franklyn Cook, Inc. RICHARD'S INSURANCE AGENCY, INC. SINE PLUMBING & HEATING CO., INC. ELECTRO STANDARDS LABORATORY, INC. Union Wadding Company Narragansett Bay Merchants, Inc. JOHN A. KINDL, INC. RAMSAY ASSOCIATES, INC.

MICHAEL B. CAPALBO

CAPALBO DENTAL GROUP OF WICKFORD, LLC WESTERLY DENTAL SPECIALISTS, LLC GARAGE DOOR GOLF, LLC

Related by address

130 GRANITE STREET, WESTERLY, RI, 02891, USA

R.B.S. REALTY, INC. Valvet, Corp. of Rhode Island SUNRISE MARKET, LLC CHILDREN'S DENTISTRY OF WESTERLY, LLC MMAKKET, LLC Extreme Freeze, llc WESTERLY DENTAL SPECIALISTS, LLC TyMark, Inc. AKCapalbo, LLC

Date of last update: 06 Apr 2025

Sources: Rhode Island Department of State

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