Provider Demographics
NPI:1568058725
Name:CAPOTE CABRERA, RONNYS (DDS)
Entity Type:Individual
Prefix:
First Name:RONNYS
Middle Name:
Last Name:CAPOTE CABRERA
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 1:4220 CLAYTON RD APT 3214
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-2742
Mailing Address - Country:US
Mailing Address - Phone:832-925-1763
Mailing Address - Fax:
Practice Address - Street 1:3025 MCHENRY AVE STE N
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-1449
Practice Address - Country:US
Practice Address - Phone:832-925-1763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1058621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice