Provider Demographics
NPI:1912909276
Name:CAPPETTA, CHRISTOPHER JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JOHN
Last Name:CAPPETTA
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 1:5282 MEDICAL DR
Mailing Address - Street 2:STE 520
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-6046
Mailing Address - Country:US
Mailing Address - Phone:210-614-5481
Mailing Address - Fax:210-614-3184
Practice Address - Street 1:5282 MEDICAL DR
Practice Address - Street 2:STE 520
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6046
Practice Address - Country:US
Practice Address - Phone:210-614-5481
Practice Address - Fax:210-614-3184
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
TX14475122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD14475OtherBLUE CROSS BLUE SHIELD
TX696159OtherUNITED CONCORDIA