Provider Demographics
NPI:1003521097
Name:CHRISTOPHER CAPENER DDS PLLC
Entity Type:Organization
Organization Name:CHRISTOPHER CAPENER DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTAILING LEAD
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA-ROCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-869-3789
Mailing Address - Street 1:3955 S DURANGO DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-4152
Mailing Address - Country:US
Mailing Address - Phone:702-242-6777
Mailing Address - Fax:702-405-2397
Practice Address - Street 1:3955 S DURANGO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-4152
Practice Address - Country:US
Practice Address - Phone:702-242-6777
Practice Address - Fax:702-405-2397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty