Provider Demographics
NPI:1427634344
Name:CAPOTE, CAROL ANN (RDH, PHDHP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:CAPOTE
Suffix:
Gender:F
Credentials:RDH, PHDHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 S WARMINSTER RD APT X8
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-4146
Mailing Address - Country:US
Mailing Address - Phone:570-807-5090
Mailing Address - Fax:
Practice Address - Street 1:503 S WARMINSTER RD APT X8
Practice Address - Street 2:
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040-4146
Practice Address - Country:US
Practice Address - Phone:570-807-5090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH068290124Q00000X
NJ22HI00845700124Q00000X
PAPHDH000442124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist