Provider Demographics
NPI:1881754745
Name:CAPOZZI, CARLA (DMD)
Entity type:Individual
Prefix:DR
First Name:CARLA
Middle Name:
Last Name:CAPOZZI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 ROUTE 130
Mailing Address - Street 2:SUITE 4001
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-1438
Mailing Address - Country:US
Mailing Address - Phone:724-744-4074
Mailing Address - Fax:724-744-7111
Practice Address - Street 1:3520 ROUTE 130
Practice Address - Street 2:SUITE 4001
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642-1438
Practice Address - Country:US
Practice Address - Phone:724-744-4074
Practice Address - Fax:724-744-7111
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025809L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics