Provider Demographics
NPI:1376947481
Name:CAPITO, LINDA
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:
Last Name:CAPITO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:BLASI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDH, BS
Mailing Address - Street 1:36197 DANIEL RD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81006-9430
Mailing Address - Country:US
Mailing Address - Phone:719-583-1525
Mailing Address - Fax:
Practice Address - Street 1:36197 DANIEL RD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81006-9430
Practice Address - Country:US
Practice Address - Phone:719-583-1525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2906124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist