Provider Demographics
NPI:1811098890
Name:CAPOGROSSO, NICHOLAS (DMD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:CAPOGROSSO
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 1:1550 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-5565
Mailing Address - Country:US
Mailing Address - Phone:908-757-2222
Mailing Address - Fax:908-755-8090
Practice Address - Street 1:1550 PARK AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5565
Practice Address - Country:US
Practice Address - Phone:908-757-2222
Practice Address - Fax:908-755-8090
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0490631223G0001X
NJDI0213381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice