Individual
DR. JACK CAPODICE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, DMD
Contact information
Practice address
109 N REGENCY DR, BLOOMINGTON, IL 61701-3515
(309) 663-2526
(309) 663-4788
Mailing address
109 N REGENCY DR, BLOOMINGTON, IL 61701-3515
(309) 663-2526
(309) 663-4788
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
019022744
IL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
019022744
IL
Other
Enumeration date
12/15/2005
Last updated
04/06/2026
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