Provider Demographics
NPI:1689859357
Name:DMG - DAYTON RJ CAPUTO DMD, LLC
Entity Type:Organization
Organization Name:DMG - DAYTON RJ CAPUTO DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CAPUTO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-366-8745
Mailing Address - Street 1:5000 MCKNIGHT RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-3420
Mailing Address - Country:US
Mailing Address - Phone:412-366-8745
Mailing Address - Fax:412-366-8737
Practice Address - Street 1:2700 MIAMISBURG CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-3738
Practice Address - Country:US
Practice Address - Phone:937-433-1494
Practice Address - Fax:937-433-7763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0226421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty