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N28w23000 Roundy Dr Ste 100 Pewaukee WI 53072-7300 | |
| (262) 970-0111 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | N28w23000 Roundy Dr Ste 100, Pewaukee, Wisconsin |
| Authorized Official Name and Position | William A Caputo (OWNER AND SOLE MEMBER) |
| Authorized Official Contact | 2245950942 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
N28w23000 Roundy Dr Ste 100 Pewaukee WI 53072-7300 Ph: (262) 970-0111 | N28w23000 Roundy Dr Ste 100 Pewaukee WI 53072-7300 Ph: (262) 970-0111 |
| NPI Number | 1598400681 |
|---|---|
| Provider Enumeration Date | 05/03/2022 |
| Last Update Date | 01/20/2025 |
| Medicare PECOS PAC ID | 5597205609 |
|---|---|
| Medicare Enrollment ID | O20240904001479 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598400681 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| 332BC3200X | Durable Medical Equipment & Medical Supplies - Customized Equipment | (* (Not Available)) | Secondary |
| Provider Name | William Alan Caputo |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1366933442 PECOS PAC ID: 2264780899 Enrollment ID: I20240904001719 |
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