Provider Demographics
NPI:1558575936
Name:CAPPELLINI, CHRISTOPHER (DDS)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:
Last Name:CAPPELLINI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-4824
Mailing Address - Country:US
Mailing Address - Phone:570-752-8753
Mailing Address - Fax:570-759-6372
Practice Address - Street 1:107 S MARKET ST
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-4824
Practice Address - Country:US
Practice Address - Phone:570-752-8753
Practice Address - Fax:570-759-6372
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029373L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015382700002Medicaid