Healthcare Provider Details

I. General information

NPI: 1396714275
Provider Name (Legal Business Name): ANTHONY M. CAPTLINE D.M.D.,J.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 BEAVER GRADE RD
CORAOPOLIS PA
15108-2653
US

IV. Provider business mailing address

890 BEAVER GRADE RD
CORAOPOLIS PA
15108-2653
US

V. Phone/Fax

Practice location:
  • Phone: 412-262-3370
  • Fax: 412-269-9525
Mailing address:
  • Phone: 412-262-3370
  • Fax: 412-269-9525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberDS015860L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: