Provider Demographics
NPI:1124380100
Name:CAPITOL HILL DENTAL GROUP
Entity Type:Organization
Organization Name:CAPITOL HILL DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOUCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-863-1600
Mailing Address - Street 1:412 1ST ST SE
Mailing Address - Street 2:2ND FLOOR, REAR BUILDING
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-1804
Mailing Address - Country:US
Mailing Address - Phone:202-863-1600
Mailing Address - Fax:202-863-1605
Practice Address - Street 1:412 1ST ST SE
Practice Address - Street 2:2ND FLOOR, REAR BUILDING
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-1804
Practice Address - Country:US
Practice Address - Phone:202-863-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC34631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty