Provider Demographics
NPI:1316169659
Name:DMG-EAST MARKET, LLLC
Entity type:Organization
Organization Name:DMG-EAST MARKET, LLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CAPUTO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-999-8533
Mailing Address - Street 1:PO BOX 827
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OH
Mailing Address - Zip Code:44202-0827
Mailing Address - Country:US
Mailing Address - Phone:412-999-8533
Mailing Address - Fax:330-562-2011
Practice Address - Street 1:135 EAST MARKET STREET
Practice Address - Street 2:SUITE 116
Practice Address - City:BLAIRSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15717-1356
Practice Address - Country:US
Practice Address - Phone:724-459-5310
Practice Address - Fax:724-459-5848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018630L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty