MEDICARE: DR. MARIO JOSEPH CAPUANO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	045939	NY

General Provider Information

NPI Number	:	1831199694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIO JOSEPH CAPUANO DDS

Provider Business Mailing Address
First Line	:	260 MIDDLE COUNTRY RD
Second Line	:	BUILDING 2, SUITE 12
City	:	SELDEN
State	:	NY
Zip	:	11784-2568
Country	:	US
Telephone Number	:	631-696-9752
Fax Number	:	631-696-5096

Provider Business Practice Location Address
First Line	:	260 MIDDLE COUNTRY RD
Second Line	:	BLDG 2 SUITE 12
City	:	SELDEN
State	:	NY
Zip	:	11784-2568
Country	:	US
Telephone Number	:	631-696-9752
Fax Number	:	631-696-5096

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	11/11/2009

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