Healthcare Provider Details

I. General information

NPI: 1598400681
Provider Name (Legal Business Name): CAPUTO DENTAL WI SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N28W23000 ROUNDY DR STE 100
PEWAUKEE WI
53072-7300
US

IV. Provider business mailing address

N28W23000 ROUNDY DR STE 100
PEWAUKEE WI
53072-7300
US

V. Phone/Fax

Practice location:
  • Phone: 262-970-0111
  • Fax:
Mailing address:
  • Phone: 262-970-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM A CAPUTO
Title or Position: OWNER AND SOLE MEMBER
Credential: DMD
Phone: 224-595-0942