Provider Demographics
NPI:1891065884
Name:CAPOZZI, RICHARD E JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:CAPOZZI
Suffix:JR
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 1:1192 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-3131
Mailing Address - Country:US
Mailing Address - Phone:860-274-9211
Mailing Address - Fax:860-274-3183
Practice Address - Street 1:1192 MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-3131
Practice Address - Country:US
Practice Address - Phone:860-274-9211
Practice Address - Fax:860-274-3183
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6939122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist