Healthcare Provider Details

I. General information

NPI: 1871805291
Provider Name (Legal Business Name): JOSEPH WAYNE CAPPS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 05/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4996 S POWER RD
MESA AZ
85212-3602
US

IV. Provider business mailing address

322 DENTAL SCIENCE BLDG S
IOWA CITY IA
52242-1001
US

V. Phone/Fax

Practice location:
  • Phone: 702-430-9000
  • Fax:
Mailing address:
  • Phone: 319-384-1139
  • Fax: 319-384-1139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number30311
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberD008686
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: