Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | D121111 | NJ |
NPI | 1467417659 |
---|---|
Provider Name | Dr. Michael Steven Cappuccilli |
First Address | Philadelphia, PA 19130-1943 |
Second Address | Somerdale, NJ 08083-1345 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0018341 | (05) | NJ |