Provider Demographics
NPI:1265634497
Name:KAPETAN, GUST G (DMD)
Entity type:Individual
Prefix:
First Name:GUST
Middle Name:G
Last Name:KAPETAN
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 1:6076 OKEECHOBEE BLVD
Mailing Address - Street 2:SUITE 20
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-4351
Mailing Address - Country:US
Mailing Address - Phone:561-687-1360
Mailing Address - Fax:
Practice Address - Street 1:6076 OKEECHOBEE BLVD
Practice Address - Street 2:SUITE 20
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-4351
Practice Address - Country:US
Practice Address - Phone:561-687-1360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17058122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist