Healthcare Provider Details

I. General information

NPI: 1831101518
Provider Name (Legal Business Name): CAPITOL DENTAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 W BANNOCK ST
BOISE ID
83702-6032
US

IV. Provider business mailing address

314 W BANNOCK ST
BOISE ID
83702-6032
US

V. Phone/Fax

Practice location:
  • Phone: 208-336-9333
  • Fax: 208-387-1951
Mailing address:
  • Phone: 208-336-9333
  • Fax: 208-387-1951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DARREL L MOONEY
Title or Position: OWNER
Credential: D.D.S., F.A.C.P.
Phone: 208-336-9333