Healthcare Provider Details

I. General information

NPI: 1619022449
Provider Name (Legal Business Name): JOLLY M CAPLASH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 HAGEN DR STE 230
ROCHESTER NY
14625-2659
US

IV. Provider business mailing address

10 HAGEN DR STE 230
ROCHESTER NY
14625-2659
US

V. Phone/Fax

Practice location:
  • Phone: 585-442-1492
  • Fax: 585-586-4460
Mailing address:
  • Phone: 585-442-1492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number048025
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: