1144874439 NPI number — DMG BRUNSWICK RD CAPUTO DMD LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144874439 NPI number — DMG BRUNSWICK RD CAPUTO DMD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DMG BRUNSWICK RD CAPUTO DMD LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144874439
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4862 STATE ROUTE 82
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANTUA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44255
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-357-8346
Provider Business Mailing Address Fax Number:
330-348-0707

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3915 CENTER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRUNSWICK
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-999-8533
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/25/2019

Additional Information

Authorized Official

Authorized Official Last Name:
CAPUTO
Authorized Official First Name:
RUSSELL
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
412-999-8533

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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