Provider Demographics
NPI:1740515568
Name:SCAPILLATO, JAMES E (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
Last Name:SCAPILLATO
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 1:6943 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1024
Mailing Address - Country:US
Mailing Address - Phone:708-848-3727
Mailing Address - Fax:708-848-6591
Practice Address - Street 1:6943 NORTH AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1024
Practice Address - Country:US
Practice Address - Phone:708-848-3727
Practice Address - Fax:708-848-6591
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A146741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice