MEDICARE: AMY OKUN CAPSHAW 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	6201	AZ

General Provider Information

NPI Number	:	1689669368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY OKUN CAPSHAW DDS

Provider Business Mailing Address
First Line	:	13660 E SHAW BUTTE DR
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85259-3768
Country	:	US
Telephone Number	:	480-471-8615
Fax Number	:	480-967-6050

Provider Business Practice Location Address
First Line	:	1050 E SOUTHERN AVE
Second Line	:	SUITE 8
City	:	TEMPE
State	:	AZ
Zip	:	85282-5403
Country	:	US
Telephone Number	:	480-967-8763
Fax Number	:	480-967-6050

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

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	07/08/2007

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