Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | D4770 | AZ |
N | 1223D0004X | Dentist Anesthesiologist | D4770 | AZ |
NPI | 1770739781 |
---|---|
Provider Name | Dr. Anthony Charles Caputo |
First Address | Tucson, AZ 85712-1256 |
Second Address | Tucson, AZ 85712-1256 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2008 |
Last Update Date | 07/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
387002 | (05) | AZ |