Provider Demographics
NPI:1124456090
Name:CAPOBIANCO, NICHOLAS GERALD (DDS)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:GERALD
Last Name:CAPOBIANCO
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Gender:M
Credentials:DDS
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Mailing Address - Street 1:1 KNEELAND ST FL 5
Mailing Address - Street 2:DEPT. OF ORAL AND MAXILLOFACIAL SURGERY
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1527
Mailing Address - Country:US
Mailing Address - Phone:617-636-6515
Mailing Address - Fax:617-636-6809
Practice Address - Street 1:1 KNEELAND ST FL 5
Practice Address - Street 2:DEPT. OF ORAL AND MAXILLOFACIAL SURGERY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1527
Practice Address - Country:US
Practice Address - Phone:617-636-6515
Practice Address - Fax:617-636-6809
Is Sole Proprietor?:No
Enumeration Date:2013-10-31
Last Update Date:2013-10-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MADN18564081223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery