Provider Demographics
NPI:1902034549
Name:CAPPELLE, SHANA L (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHANA
Middle Name:L
Last Name:CAPPELLE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:L
Other - Last Name:REESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:3415 ROGERS RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-3809
Mailing Address - Country:US
Mailing Address - Phone:919-435-1775
Mailing Address - Fax:919-435-0437
Practice Address - Street 1:3607 DAVIS DR
Practice Address - Street 2:SUITE 209
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-6004
Practice Address - Country:US
Practice Address - Phone:919-469-2122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9887122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3297700Medicaid