Provider Demographics
NPI:1164575957
Name:DMG - SOUTH MAIN, LLC
Entity Type:Organization
Organization Name:DMG - SOUTH MAIN, LLC
Other - Org Name:CAPUTO DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CAPUTO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-635-0710
Mailing Address - Street 1:5000 MCKNIGHT RD
Mailing Address - Street 2:SUITE 403
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-3420
Mailing Address - Country:US
Mailing Address - Phone:412-366-8745
Mailing Address - Fax:412-366-8737
Practice Address - Street 1:506 S MAIN ST
Practice Address - Street 2:SUITE 2103
Practice Address - City:ZELIENOPLE
Practice Address - State:PA
Practice Address - Zip Code:16063-1603
Practice Address - Country:US
Practice Address - Phone:724-453-1200
Practice Address - Fax:724-452-1585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026835L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty