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General NPI Number Information
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NPI Number | 1316169659
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Entity Type | Organization
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Legal Business Name | DMG-EAST MARKET, LLLC
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 02/03/2012
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Provider Practice Location Address
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Address Line | 135 EAST MARKET STREET SUITE 116
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City | BLAIRSVILLE
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State | PA
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Zip | 15717-1356
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Country | US
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Telephone | 724-459-5310
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Fax | 724-459-5848
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Provider Business Mailing Address
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Address Line | PO BOX 827
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City | AURORA
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State | OH
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Zip | 44202-0827
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Country | US
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Telephone | 412-999-8533
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Fax | 330-562-2011
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Authorized Official
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Title or Position | OWNER
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Name | DR. RUSSELL JAMES CAPUTO
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Credential | DMD
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Telephone | 412-999-8533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS018630L
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License Number State | PA
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