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General NPI Number Information
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NPI Number | 1285014274
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Entity Type | Organization
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Legal Business Name | DIPA CAPPELEN, D.M.D., P.C.
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Dates
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Enumeration Date | 06/04/2015
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Last Update Date | 06/04/2015
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Provider Practice Location Address
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Address Line | 912 GRAND AVE STE 201
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City | SAN RAFAEL
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State | CA
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Zip | 94901-3552
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Country | US
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Telephone | 415-456-8735
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Fax | 415-456-1838
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Provider Business Mailing Address
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Address Line | 912 GRAND AVE STE 201
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City | SAN RAFAEL
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State | CA
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Zip | 94901-3552
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Country | US
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Telephone | 415-456-8735
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Fax | 415-456-1838
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Authorized Official
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Title or Position | OWNER
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Name | DR. DIPA CAPPELEN
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Credential | DMD
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Telephone | 415-456-8735
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 60454
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License Number State | CA
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