Provider Demographics
NPI:1417239294
Name:CAPESTANY, NOEL IVAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:NOEL
Middle Name:IVAN
Last Name:CAPESTANY
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 1:1705 BELLE VIEW BLVD
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22307-6726
Mailing Address - Country:US
Mailing Address - Phone:703-660-8888
Mailing Address - Fax:703-660-9289
Practice Address - Street 1:1705 BELLE VIEW BLVD
Practice Address - Street 2:SUITE A-1
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22307-6726
Practice Address - Country:US
Practice Address - Phone:703-660-8888
Practice Address - Fax:703-660-9289
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA83651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice