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General NPI Number Information
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NPI Number | 1639488869
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Entity Type | Organization
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Legal Business Name | CAPITAL DENTAL CARE PLLC
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Dates
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Enumeration Date | 10/05/2010
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Last Update Date | 10/05/2010
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Provider Practice Location Address
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Address Line | 165 MANNING BLVD
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City | ALBANY
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State | NY
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Zip | 12203-1756
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Country | US
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Telephone | 518-459-2444
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Fax | 518-459-2445
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Provider Business Mailing Address
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Address Line | 165 MANNING BLVD
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City | ALBANY
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State | NY
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Zip | 12203-1756
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Country | US
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Telephone | 518-459-2444
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Fax | 518-459-2445
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Authorized Official
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Title or Position | OWNER
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Name | DR. OMAR ALWAKFI
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Credential | DMD
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Telephone | 518-459-2444
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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 | 046831
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License Number State | NY
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