Healthcare Provider Details

I. General information

NPI: 1710501895
Provider Name (Legal Business Name): CAPITOL OMS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 04/19/2025
Certification Date: 04/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 18TH ST NW STE 203
WASHINGTON DC
20036-6501
US

IV. Provider business mailing address

1325 18TH ST NW STE 203
WASHINGTON DC
20036-6501
US

V. Phone/Fax

Practice location:
  • Phone: 202-716-7626
  • Fax:
Mailing address:
  • Phone: 202-716-7626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS SHIN
Title or Position: OWNER
Credential: DMD
Phone: 202-716-7626