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General NPI Number Information
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NPI Number | 1164831384
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Entity Type | Organization
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Legal Business Name | CAPITOL HILL DENTISTRY & BRACES PLLC
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Dates
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Enumeration Date | 08/13/2014
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Last Update Date | 11/09/2020
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Provider Practice Location Address
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Address Line | 235 SW 25TH ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73109-5927
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Country | US
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Telephone | 405-295-4967
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Fax | 405-295-4969
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Provider Business Mailing Address
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Address Line | 235 SW 25TH ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73109-5927
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. BENJAMIN BOWMAN
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Credential | D.D.S.
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Telephone | 405-326-8004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6076
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License Number State | OK
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