Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | DN 8125 | FL |
N | 1223S0112X | Oral and Maxillofacial Surgeon | DN 8125 | FL |
NPI | 1881750974 |
---|---|
Provider Name | Lewis Anthony Caputa, Jr. |
First Address | Orange Park, FL 32073-4537 |
Second Address | Orange Park, FL 32073-4537 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U22221 | (02) | FL |