Provider Demographics
NPI:1750565685
Name:CLIFFORD B CAPPELLI DMD PC
Entity type:Organization
Organization Name:CLIFFORD B CAPPELLI DMD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:BERND
Authorized Official - Last Name:CAPPELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:970-625-1696
Mailing Address - Street 1:527 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:RIFLE
Mailing Address - State:CO
Mailing Address - Zip Code:81650-3553
Mailing Address - Country:US
Mailing Address - Phone:970-625-1696
Mailing Address - Fax:970-625-1992
Practice Address - Street 1:527 WEST AVE
Practice Address - Street 2:
Practice Address - City:RIFLE
Practice Address - State:CO
Practice Address - Zip Code:81650-3553
Practice Address - Country:US
Practice Address - Phone:970-625-1696
Practice Address - Fax:970-625-1992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO77471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty