Provider Demographics
NPI:1396714275
Name:CAPTLINE, ANTHONY M (DMD,JD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:M
Last Name:CAPTLINE
Suffix:
Gender:M
Credentials:DMD,JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 BEAVER GRADE RD
Mailing Address - Street 2:
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2653
Mailing Address - Country:US
Mailing Address - Phone:412-262-3370
Mailing Address - Fax:412-269-9525
Practice Address - Street 1:890 BEAVER GRADE RD
Practice Address - Street 2:
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-2653
Practice Address - Country:US
Practice Address - Phone:412-262-3370
Practice Address - Fax:412-269-9525
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS015860L1223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACA061708Medicare ID - Type UnspecifiedPROVIDER NUMBER