Dr. Jack Capodice JR.
Oral and Maxillofacial Pathology
109 N Regency Dr
Bloomington
, Illinois 61701-3515
Dr. Jack Capodice JR.
Oral and Maxillofacial Pathology
109 N Regency Dr
Bloomington
, Illinois 61701-3515
(309) 663-4788
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About
Features
Specialties
- Oral and Maxillofacial Pathology
Languages spoken
- English
Location
First Address
- Dr. Jack Capodice JR.
- 109 N Regency Dr
- Bloomington, IL
- Zip : 61701-3515
- Fax : (309) 663-4788
- Phone : (309) 663-2526
Second Address
- Dr. Jack Capodice JR.
- 109 N Regency Dr
- Bloomington, IL
- Zip : 61701-3515
- Fax : (309) 663-4788
- Phone : (309) 663-2526
Reviews
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 1223P0106X | Oral and Maxillofacial Pathology | 019022744 | IL |
National Provider Identifier
| NPI | 1053397612 |
|---|---|
| Provider Name | Dr. Jack Capodice JR. |
| First Address | Bloomington, IL 61701-3515 |
| Second Address | Bloomington, IL 61701-3515 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 15/12/2005 |
| Last Update Date | 01/07/2019 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| BC0670174 | DEA (01) | IL |
| F40908 | (02) | IL |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.