Provider Demographics
NPI:1427065184
Name:JACAPRARO, STEPHEN ROBERT (DMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ROBERT
Last Name:JACAPRARO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1379 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-2500
Mailing Address - Country:US
Mailing Address - Phone:413-786-8177
Mailing Address - Fax:413-789-1738
Practice Address - Street 1:1379 MAIN ST
Practice Address - Street 2:
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001-2500
Practice Address - Country:US
Practice Address - Phone:413-786-8177
Practice Address - Fax:413-789-1738
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12506122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist