Basic Information
Provider Information | |||||||||
NPI: | 1568950749 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CAPERS | ||||||||
FirstName: | JAMES | ||||||||
MiddleName: | BRYANT | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | DDS | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4881 SUGAR MAPLE DRIVE | ||||||||
Address2: |   | ||||||||
City: | WRIGHT-PATTERSON AFB | ||||||||
State: | OH | ||||||||
PostalCode: | 45433 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9372578349 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 51 MDG UNIT 2060 | ||||||||
Address2: |   | ||||||||
City: | OSAN AB | ||||||||
State: | AP | ||||||||
PostalCode: | 96278-2060 | ||||||||
CountryCode: | KR | ||||||||
TelephoneNumber: | 3157848717 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/24/2018 | ||||||||
LastUpdateDate: | 07/28/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/28/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 10742 | TN | Y |   | Dental Providers | Dentist |   |
No ID Information.