Provider Demographics
NPI:1144874439
Name:DMG BRUNSWICK RD CAPUTO DMD LLC
Entity type:Organization
Organization Name:DMG BRUNSWICK RD CAPUTO DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CAPUTO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-999-8533
Mailing Address - Street 1:4862 STATE ROUTE 82
Mailing Address - Street 2:
Mailing Address - City:MANTUA
Mailing Address - State:OH
Mailing Address - Zip Code:44255
Mailing Address - Country:US
Mailing Address - Phone:330-357-8346
Mailing Address - Fax:330-348-0707
Practice Address - Street 1:3915 CENTER RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212
Practice Address - Country:US
Practice Address - Phone:412-999-8533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL MANAGEMENT GROUP LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty