MEDICARE: CAPITOL OMS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1710501895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPITOL OMS PLLC

Provider Business Mailing Address
First Line	:	1325 18TH ST NW STE 203
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20036-6501
Country	:	US
Telephone Number	:	202-716-7626
Fax Number	:

Provider Business Practice Location Address
First Line	:	1325 18TH ST NW STE 203
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20036-6501
Country	:	US
Telephone Number	:	202-716-7626
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. THOMAS SHIN
Credential	:	DMD
Telephone Number	:	202-716-7626

Provider Enumeration Date	:	06/03/2020
Last Update Date	:	04/19/2025

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