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General NPI Number Information
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NPI Number | 1063604684
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Entity Type | Organization
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Legal Business Name | CAPITOL PERIODONTAL GROUP
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Dates
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Enumeration Date | 08/16/2007
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Last Update Date | 08/16/2007
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Provider Practice Location Address
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Address Line | 9309 OFFICE PARK CIR STE 110
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City | ELK GROVE
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State | CA
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Zip | 95758-8072
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Country | US
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Telephone | 916-684-3379
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Fax | 916-684-4106
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Provider Business Mailing Address
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Address Line | PO BOX 255747
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City | SACRAMENTO
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State | CA
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Zip | 95865-5747
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Country | US
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Telephone | 916-394-6555
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Fax | 916-394-6545
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Authorized Official
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Title or Position | FINANCIAL ASSISTANT
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Name | SUSAN DILWORTH
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Credential |
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Telephone | 916-394-6555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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