Provider Demographics
NPI:1356472211
Name:CAPOBIANCO, ARNOLD R (DMD)
Entity Type:Individual
Prefix:DR
First Name:ARNOLD
Middle Name:R
Last Name:CAPOBIANCO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-4252
Mailing Address - Country:US
Mailing Address - Phone:321-269-7997
Mailing Address - Fax:321-383-2028
Practice Address - Street 1:1425 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-4252
Practice Address - Country:US
Practice Address - Phone:321-269-7997
Practice Address - Fax:321-383-2028
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL81241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice