Healthcare Provider Details

I. General information

NPI: 1518139443
Provider Name (Legal Business Name): CAPITAL CITY DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 THURMAN AVE
COLUMBUS OH
43206-2685
US

IV. Provider business mailing address

79 THURMAN AVE
COLUMBUS OH
43206-2685
US

V. Phone/Fax

Practice location:
  • Phone: 614-443-4625
  • Fax: 614-443-6558
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number17428
License Number StateOH

VIII. Authorized Official

Name: DR. DAVID GEORGE SZANA
Title or Position: OWNER
Credential:
Phone: 614-443-4625