Healthcare Provider Details

I. General information

NPI: 1134361157
Provider Name (Legal Business Name): CAPITOL DENTAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2717 N HWY 89 STE 100
PLEASANT VIEW UT
84404-1230
US

IV. Provider business mailing address

1245 CAPITOL ST SUITE 121-N
OGDEN UT
84401-2847
US

V. Phone/Fax

Practice location:
  • Phone: 801-621-8000
  • Fax:
Mailing address:
  • Phone: 801-621-8000
  • Fax: 801-621-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number373461
License Number StateUT

VIII. Authorized Official

Name: DR. JAMES N JONES JR.
Title or Position: OWNER
Credential: DMD
Phone: 801-621-8000