Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 019032024 | IL |
Y | 1223P0221X | Pediatric Dentist | 021003065 | IL |
NPI | 1033613625 |
---|---|
Provider Name | Dr. Nicholas Eugene Capezio |
First Address | Chicago, IL 60612-7210 |
Second Address | Buffalo Grove, IL 60089-1796 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2018 |
Last Update Date | 16/07/2021 |