Provider Demographics
NPI:1043572969
Name:CAPPETTA, EMIL JOHN ARMAND (DDS)
Entity Type:Individual
Prefix:DR
First Name:EMIL
Middle Name:JOHN ARMAND
Last Name:CAPPETTA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:54 PLYMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2137
Mailing Address - Country:US
Mailing Address - Phone:973-746-3466
Mailing Address - Fax:973-783-4157
Practice Address - Street 1:54 PLYMOUTH ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2137
Practice Address - Country:US
Practice Address - Phone:973-746-3466
Practice Address - Fax:973-783-4157
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1025649001223S0112X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery