Healthcare Provider Details

I. General information

NPI: 1770082125
Provider Name (Legal Business Name): CAPITOL ORAL, FACIAL & IMPLANT SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 02/12/2018
Certification Date:
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 Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

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