Provider Demographics
NPI:1598400681
Name:CAPUTO DENTAL WI SC
Entity Type:Organization
Organization Name:CAPUTO DENTAL WI SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAPUTO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:224-595-0942
Mailing Address - Street 1:N28W23000 ROUNDY DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-7300
Mailing Address - Country:US
Mailing Address - Phone:262-970-0111
Mailing Address - Fax:
Practice Address - Street 1:N28W23000 ROUNDY DR STE 100
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-7300
Practice Address - Country:US
Practice Address - Phone:262-970-0111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental