Healthcare Provider Details

I. General information

NPI: 1053304493
Provider Name (Legal Business Name): ALFRED O CAPPELLI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: CHRISTOPHER M CAPPELLI DDS

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 BROADWAY
HILLSDALE NJ
07642-2034
US

IV. Provider business mailing address

156 BROADWAY
HILLSDALE NJ
07642-2034
US

V. Phone/Fax

Practice location:
  • Phone: 201-666-8989
  • Fax: 201-666-8999
Mailing address:
  • Phone: 201-666-8989
  • Fax: 201-666-8999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDI00849400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: