Provider Demographics
NPI:1225165533
Name:CAPITAL CITY DENTAL, INC
Entity Type:Organization
Organization Name:CAPITAL CITY DENTAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:HORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:775-883-6700
Mailing Address - Street 1:725 N MINNESOTA ST
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-3954
Mailing Address - Country:US
Mailing Address - Phone:775-883-6700
Mailing Address - Fax:775-883-6701
Practice Address - Street 1:725 N MINNESOTA ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-3954
Practice Address - Country:US
Practice Address - Phone:775-883-6700
Practice Address - Fax:775-883-6701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4704261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental