Provider Demographics
NPI:1760356208
Name:CAPSTONE DERMATOLOGY
Entity type:Organization
Organization Name:CAPSTONE DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MONA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-267-5890
Mailing Address - Street 1:1100 E DIMOND BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-2001
Mailing Address - Country:US
Mailing Address - Phone:907-232-0251
Mailing Address - Fax:
Practice Address - Street 1:1100 E DIMOND BLVD STE 103
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-2001
Practice Address - Country:US
Practice Address - Phone:907-267-5890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED DERMATOLOGY OF ALASKA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-09-29
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric DermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty