Provider Demographics
NPI:1033423959
Name:CAPILOUTO, MARY LYNNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:LYNNE
Last Name:CAPILOUTO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 DEXTER AVE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-3723
Mailing Address - Country:US
Mailing Address - Phone:205-879-7300
Mailing Address - Fax:
Practice Address - Street 1:301 DEXTER AVE
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-3723
Practice Address - Country:US
Practice Address - Phone:205-879-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3337122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist