Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. JACK CAPODICE JR., MD, DMD
ActiveDR. JACK CAPODICE JR., MD, DMD is a Orthodontics & Dentofacial Orthopedics healthcare provider located in BLOOMINGTON, Illinois. NPI 1053397612 is currently active in the NPPES registry. Verify at CMS.
Orthodontics & Dentofacial Orthopedics · BLOOMINGTON, IL
Registration Details
- NPI Number
- 1053397612
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Dec 15, 2005 (20.696695781438 yrs)
- Last Updated
- Mar 7, 2023
- License
-
019022744 (IL)
Practice Information
- Address
-
109 N REGENCY DRBLOOMINGTON, IL, 617013515Browse IL providers · Browse ZIP 61701
- Phone
- 3096632526
- Fax
- 3096634788
- Primary Specialty
-
Orthodontics & Dentofacial Orthopedics
1223P0106X
Other Orthodontics & Dentofacial Orthopedics Providers in BLOOMINGTON, IL
| Name | Credential | NPI |
|---|---|---|
| DR. DAVID EFAW | MD, DDS | 1700862877 |
| DR. THOMAS CHARLES OCHELTREE JR. | DMD | 1205892973 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.