Capodice, Jack
Capodice, Jack is an individual health care provider with primary practice located at 109 N Regency Dr , Bloomington IL 61701-3515. He recently has only one registered license in Dental Providers / Oral and Maxillofacial Pathology, which is considered as his primary health care specialty. Capodice, Jack can be contacted via phone (309) 663-2526.Contact Information
Primary practice address
109 N Regency Dr
Bloomington IL 61701-3515
Phone: (309) 663-2526
Fax: (309) 663-4788
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Oral and Maxillofacial Pathology | 1223P0106X | 019022744 | Illinois |
Profile Details
| NPI number | 1053397612 |
|---|---|
| LBN Legal business name | Capodice, Jack |
| Credentials | MD, DMD |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 15th, 2005 |
| Last updated | Mar 7th, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
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