Healthcare Provider Details

I. General information

NPI: 1245301522
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL CAPPELLI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
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

235 W PASSAIC ST APARTMENT C-16
ROCHELLE PARK NJ
07662-3123
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 Number22DI02164900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: