MEDICARE: DR. MARY PAULA CAPASSO VILLAGRA 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	28165	FL

General Provider Information

NPI Number	:	1801535240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY PAULA CAPASSO VILLAGRA DDS

Provider Business Mailing Address
First Line	:	1528 RINEHART RD
Second Line	:
City	:	SANFORD
State	:	FL
Zip	:	32771-7497
Country	:	US
Telephone Number	:	407-792-3987
Fax Number	:

Provider Business Practice Location Address
First Line	:	1528 RINEHART RD
Second Line	:
City	:	SANFORD
State	:	FL
Zip	:	32771-7497
Country	:	US
Telephone Number	:	407-792-3987
Fax Number	:

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

Provider Enumeration Date	:	06/02/2022
Last Update Date	:	10/20/2023

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