Jack Capodice JR. MD, DMD

NPI 1053397612 - Dentist - 1223P0106X

NPI Details
NPI 1053397612
Gender Male
Enumeration Date 12/15/2005
Last Updated 07/09/2007
Entity Type Individual
Active Over 10 years ago
Practice Location
109 N REGENCY DR
BLOOMINGTON IL, 61701-3515, US
Phone (309) 663-2526
Fax (309) 663-4788
Business Location
109 N REGENCY DR
BLOOMINGTON IL, 61701-3515, US
Phone (309) 663-2526
Fax (309) 663-4788
Toxanomy
Taxonomy Code 1223P0106X
License State
License Number
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According to our database, Dr. Jack Capodice JR. MD, DMD NPI is 1053397612, taxonomy code is 1223P0106X Jack Capodice JR. MD, DMD physically located at 109 N Regency Dr, Bloomington IL, 61701-3515. NPI Number Jack Capodice JR. MD, DMD has the Individual type.

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1053397612 NPI number is provided on an as is basis without warranty of any kind. 1053397612 is maintained by the National Plan & Provider Enumeration System. The contents of Jack Capodice JR. MD, DMD are for informational purposes only.