Provider Demographics
NPI:1043818503
Name:CAPESTANY, AIDAILIS (DDS)
Entity type:Individual
Prefix:
First Name:AIDAILIS
Middle Name:
Last Name:CAPESTANY
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:AIDAILIS
Other - Middle Name:
Other - Last Name:GONZALEZ IGLESIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8540 RESEDA BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-6144
Mailing Address - Country:US
Mailing Address - Phone:818-701-6667
Mailing Address - Fax:
Practice Address - Street 1:8540 RESEDA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-6144
Practice Address - Country:US
Practice Address - Phone:818-701-6667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105694122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist