Provider Demographics
NPI:1689669368
Name:OKUN CAPSHAW, AMY (DDS)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:OKUN CAPSHAW
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:M
Other - Last Name:OKUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:13660 E SHAW BUTTE DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-3768
Mailing Address - Country:US
Mailing Address - Phone:480-471-8615
Mailing Address - Fax:480-967-6050
Practice Address - Street 1:1050 E SOUTHERN AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-5403
Practice Address - Country:US
Practice Address - Phone:480-967-8763
Practice Address - Fax:480-967-6050
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6201122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist