Provider Demographics
NPI:1639573702
Name:CAPURRO, ANTONINA (DMD, MPH)
Entity Type:Individual
Prefix:DR
First Name:ANTONINA
Middle Name:
Last Name:CAPURRO
Suffix:
Gender:F
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:ANTONINA
Other - Middle Name:
Other - Last Name:LARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3901 BOCA GRANDE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-2040
Mailing Address - Country:US
Mailing Address - Phone:702-823-4628
Mailing Address - Fax:
Practice Address - Street 1:1001 SHADOW LN
Practice Address - Street 2:MS 7411
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4124
Practice Address - Country:US
Practice Address - Phone:702-774-2573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLL-384-141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice