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General NPI Number Information
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NPI Number | 1720138977
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Entity Type | Organization
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Legal Business Name | CAPATI DENTAL, LLC
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 07/23/2008
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Provider Practice Location Address
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Address Line | 1027 S 2ND ST
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City | SPRINGFIELD
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State | IL
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Zip | 62704-3004
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Country | US
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Telephone | 217-522-4451
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Fax | 217-522-3980
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Provider Business Mailing Address
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Address Line | 1027 S 2ND ST
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City | SPRINGFIELD
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State | IL
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Zip | 62704-3004
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Country | US
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Telephone | 217-522-4451
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Fax | 217-522-3980
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. SHAY L CRAWFORD
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Credential | CDPMA
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Telephone | 217-522-4451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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