Provider Demographics
NPI:1659562452
Name:CAPOBIANCO, WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:CAPOBIANCO
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 1:665 CAMINO DE LOS MARES
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673
Mailing Address - Country:US
Mailing Address - Phone:949-443-2404
Mailing Address - Fax:949-443-2324
Practice Address - Street 1:665 CAMINO DE LOS MARES
Practice Address - Street 2:SUITE 303
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673
Practice Address - Country:US
Practice Address - Phone:949-443-2404
Practice Address - Fax:949-443-2324
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA392411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice