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General NPI Number Information
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NPI Number | 1508014499
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Entity Type | Organization
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Legal Business Name | CAPITOL CLINICAL DENTAL SERVICES, PLLC
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Dates
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Enumeration Date | 09/04/2008
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Last Update Date | 09/04/2008
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Provider Practice Location Address
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Address Line | 2737 A DEVONSHIRE PLACE NW
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City | WASHINGTON
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State | DC
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Zip | 20008-1654
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Country | US
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Telephone | 202-232-1117
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Fax | 202-232-1911
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Provider Business Mailing Address
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Address Line | 2737 A DEVONSHIRE PLACE NW
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City | WASHINGTON
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State | DC
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Zip | 20008-1654
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Country | US
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Telephone | 202-232-1117
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Fax | 202-232-1911
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. RENEE AVA MCCOY-COLLINS
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Credential | DDS
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Telephone | 202-232-1117
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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 | DEN2228
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DEN1000290
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DEN1000625
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License Number State | DC
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Taxonomy #4
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DEN3652
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License Number State | DC
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