Provider Demographics
NPI:1508014499
Name:CAPITOL CLINICAL DENTAL SERVICES, PLLC
Entity Type:Organization
Organization Name:CAPITOL CLINICAL DENTAL SERVICES, PLLC
Other - Org Name:CAPITOL DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:AVA
Authorized Official - Last Name:MCCOY-COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-232-1117
Mailing Address - Street 1:2737 A DEVONSHIRE PLACE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-1654
Mailing Address - Country:US
Mailing Address - Phone:202-232-1117
Mailing Address - Fax:202-232-1911
Practice Address - Street 1:2737 A DEVONSHIRE PLACE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-1654
Practice Address - Country:US
Practice Address - Phone:202-232-1117
Practice Address - Fax:202-232-1911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN22281223G0001X
DCDEN10002901223G0001X
DCDEN36521223S0112X
DCDEN10006251223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty