Provider Demographics
NPI:1770101404
Name:CAPOZZA, GAETANO RICARDO (DMD)
Entity type:Individual
Prefix:DR
First Name:GAETANO
Middle Name:RICARDO
Last Name:CAPOZZA
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 1:9669 AVELLINO AVE UNIT 6315
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8857
Mailing Address - Country:US
Mailing Address - Phone:407-508-0743
Mailing Address - Fax:
Practice Address - Street 1:8801 COMMODITY CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-9053
Practice Address - Country:US
Practice Address - Phone:407-248-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN25074122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty