MEDICARE: NORTH BABYLON DENTAL, P.C.

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	1223G0001X	General Practice Dentistry	036209	NY

General Provider Information

NPI Number	:	1750500146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH BABYLON DENTAL, P.C.

Provider Business Mailing Address
First Line	:	837 DEER PARK AVE
Second Line	:
City	:	NORTH BABYLON
State	:	NY
Zip	:	11703-3811
Country	:	US
Telephone Number	:	631-587-4545
Fax Number	:	631-587-4752

Provider Business Practice Location Address
First Line	:	837 DEER PARK AVE
Second Line	:
City	:	NORTH BABYLON
State	:	NY
Zip	:	11703-3811
Country	:	US
Telephone Number	:	631-587-4545
Fax Number	:	631-587-4752

Authorized Official
Title or Position	:	OWNER
Name	:	DR. VINCENT KEITH CAPONE
Credential	:	D.M.D.
Telephone Number	:	631-587-4545

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	08/22/2020

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