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General NPI Number Information
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NPI Number | 1780092171
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Entity Type | Organization
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Legal Business Name | KENNETH R. CAPOZZI DDS LLC
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Dates
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Enumeration Date | 07/29/2014
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Last Update Date | 07/29/2014
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Provider Practice Location Address
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Address Line | 158 WATERBURY RD
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City | PROSPECT
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State | CT
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Zip | 06712-1229
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Country | US
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Telephone | 203-758-4224
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Fax |
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Provider Business Mailing Address
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Address Line | 158 WATERBURY RD
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City | PROSPECT
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State | CT
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Zip | 06712-1229
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Country | US
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Telephone | 203-758-4224
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KENNETH CAPOZZI
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Credential | DDS
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Telephone | 203-758-4224
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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 | 8439CT
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License Number State | CT
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