Healthcare Provider Details

I. General information

NPI: 1538701594
Provider Name (Legal Business Name): JOHN CAPPARELL & CONNIE MALLOZZI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 N LAUREL ST # 2-C
HAZLETON PA
18201-5948
US

IV. Provider business mailing address

20 N LAUREL ST # 2-C
HAZLETON PA
18201-5948
US

V. Phone/Fax

Practice location:
  • Phone: 570-454-9600
  • Fax:
Mailing address:
  • Phone: 570-454-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JOHN WILLIAM CAPPARELL
Title or Position: PARTNER
Credential: DMD
Phone: 570-454-9600