Provider Demographics
NPI:1982775920
Name:CAPO, LUIS A (DMD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:A
Last Name:CAPO
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:PO BOX 7918
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00986-7918
Mailing Address - Country:US
Mailing Address - Phone:787-257-7920
Mailing Address - Fax:787-257-7920
Practice Address - Street 1:VILLA CAROLINA
Practice Address - Street 2:139-12 CALLE 401
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-257-7920
Practice Address - Fax:787-257-7920
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1669122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist