Provider Demographics
NPI:1477637114
Name:CAPUTO, JASON A (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:A
Last Name:CAPUTO
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 MARKET PLACE DR
Mailing Address - Street 2:
Mailing Address - City:MOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27028-2084
Mailing Address - Country:US
Mailing Address - Phone:336-753-6630
Mailing Address - Fax:336-753-6632
Practice Address - Street 1:113 MARKET PLACE DR
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-2084
Practice Address - Country:US
Practice Address - Phone:336-753-6630
Practice Address - Fax:336-753-6632
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC78341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice