Provider Demographics
NPI:1245924067
Name:CAPONE, MOLLIE (DMD)
Entity type:Individual
Prefix:
First Name:MOLLIE
Middle Name:
Last Name:CAPONE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 RAVINE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:GATE CITY
Mailing Address - State:VA
Mailing Address - Zip Code:24251-3312
Mailing Address - Country:US
Mailing Address - Phone:276-386-6162
Mailing Address - Fax:
Practice Address - Street 1:116 RAVINE ST STE 101
Practice Address - Street 2:
Practice Address - City:GATE CITY
Practice Address - State:VA
Practice Address - Zip Code:24251-3312
Practice Address - Country:US
Practice Address - Phone:276-386-6162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12244122300000X
VA04014191081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist