Basic Information
| Provider Information | |||||||||
| NPI: | 1154631133 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAPETILLO | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | FERNANDO | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 618TH DENTAL COMPANY | ||||||||
| Address2: | UNIT 15652, BLDG S5403 | ||||||||
| City: | APO | ||||||||
| State: | AP | ||||||||
| PostalCode: | 96205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157372600 | ||||||||
| FaxNumber: | 3157367703 | ||||||||
| Practice Location | |||||||||
| Address1: | BLDG # 36014 WRATTEN AVE | ||||||||
| Address2: | |||||||||
| City: | FORT HOOD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2542867401 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2010 | ||||||||
| LastUpdateDate: | 08/06/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 25896 | TX | N | Dental Providers | Dentist | 1223P0300X | 25896 | TX | Y | Dental Providers | Dentist | Periodontics |
No ID Information.