Provider Demographics
NPI:1902976095
Name:KAPUSTA, MARTIN ANTHONY JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:ANTHONY
Last Name:KAPUSTA
Suffix:JR
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:PO BOX 360
Mailing Address - Street 2:125 W PENNA AVE
Mailing Address - City:NEW STANTON
Mailing Address - State:PA
Mailing Address - Zip Code:15672-9470
Mailing Address - Country:US
Mailing Address - Phone:724-925-8888
Mailing Address - Fax:
Practice Address - Street 1:125 W PENNA AVE
Practice Address - Street 2:
Practice Address - City:NEW STANTON
Practice Address - State:PA
Practice Address - Zip Code:15672-9470
Practice Address - Country:US
Practice Address - Phone:724-925-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021221L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA32685OtherUNITED CONCORDIA