MEDICARE: DR. TERESA ANGELINE CAPRISTO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DS039138	PA

General Provider Information

NPI Number	:	1104171735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERESA ANGELINE CAPRISTO DDS

Provider Business Mailing Address
First Line	:	1058 S MAIN ST
Second Line	:	STE 1A
City	:	MEADVILLE
State	:	PA
Zip	:	16335
Country	:	US
Telephone Number	:	814-671-3344
Fax Number	:

Provider Business Practice Location Address
First Line	:	1058 S MAIN ST
Second Line	:	STE 1A
City	:	MEADVILLE
State	:	PA
Zip	:	16335
Country	:	US
Telephone Number	:	814-671-3344
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2012
Last Update Date	:	05/26/2026

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