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General NPI Number Information
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NPI Number | 1821273582
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Entity Type | Organization
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Legal Business Name | DMG-SALEM RJ CAPUTO, DMD, LLC
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Dates
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Enumeration Date | 12/31/2007
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Last Update Date | 12/31/2007
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Provider Practice Location Address
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Address Line | 5200 SALEM AVE
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City | DAYTON
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State | OH
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Zip | 45426-1708
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Country | US
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Telephone | 937-854-7617
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Fax | 937-837-1554
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Provider Business Mailing Address
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Address Line | 5000 MCKNIGHT RD SUITE 206
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City | PITTSBURGH
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State | PA
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Zip | 15237-3420
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Country | US
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Telephone | 412-366-8745
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Fax | 412-366-8737
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Authorized Official
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Title or Position | OWNER
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Name | RUSSELL J CAPUTO
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Credential | D.M.D
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Telephone | 412-366-8745
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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 | 30-022642
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License Number State | OH
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