Provider Demographics
NPI:1700880655
Name:CAPONE, PETER PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:PAUL
Last Name:CAPONE
Suffix:
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 1:38 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4596
Mailing Address - Country:US
Mailing Address - Phone:607-722-1274
Mailing Address - Fax:607-723-8888
Practice Address - Street 1:38 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4596
Practice Address - Country:US
Practice Address - Phone:607-722-1274
Practice Address - Fax:607-723-8888
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY426551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02207550Medicaid