Provider Demographics
NPI:1891962536
Name:CAPENER, ROBERT JERRY (DMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JERRY
Last Name:CAPENER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 N WASHINGTON BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-3348
Mailing Address - Country:US
Mailing Address - Phone:180-173-7577
Mailing Address - Fax:801-782-4674
Practice Address - Street 1:1690 N WASHINGTON BLVD STE 1
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84404-3348
Practice Address - Country:US
Practice Address - Phone:180-173-7577
Practice Address - Fax:801-782-4674
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT324711-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice