MEDICARE: DMG-SALEM RJ CAPUTO, DMD, LLC

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	30-022642	OH

General Provider Information

NPI Number	:	1821273582
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DMG-SALEM RJ CAPUTO, DMD, LLC

Provider Business Mailing Address
First Line	:	5000 MCKNIGHT RD
Second Line	:	SUITE 206
City	:	PITTSBURGH
State	:	PA
Zip	:	15237-3420
Country	:	US
Telephone Number	:	412-366-8745
Fax Number	:	412-366-8737

Provider Business Practice Location Address
First Line	:	5200 SALEM AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45426-1708
Country	:	US
Telephone Number	:	937-854-7617
Fax Number	:	937-837-1554

Authorized Official
Title or Position	:	OWNER
Name	:	RUSSELL J CAPUTO
Credential	:	D.M.D
Telephone Number	:	412-366-8745

Provider Enumeration Date	:	12/31/2007
Last Update Date	:	12/31/2007

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