Healthcare Provider Details

I. General information

NPI: 1811413719
Provider Name (Legal Business Name): CAP DENTAL CARE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 08/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N WASHINGTON ST.
NAPERVILLE IL
60563
US

IV. Provider business mailing address

555 N. WASHINGTON ST
NAPERVILLE IL
60563
US

V. Phone/Fax

Practice location:
  • Phone: 630-420-1212
  • Fax: 630-420-0300
Mailing address:
  • Phone: 630-420-1212
  • Fax: 630-420-0300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.029414
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.029414
License Number StateIL

VIII. Authorized Official

Name: KAIYAN CHEN
Title or Position: PRESIDENT
Credential: DDS
Phone: 708-689-9558