Provider Demographics
NPI:1568597516
Name:CAPITAL PERIODONTAL GROUP
Entity Type:Organization
Organization Name:CAPITAL PERIODONTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ARISTIDIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PONTIKAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MS
Authorized Official - Phone:916-971-3461
Mailing Address - Street 1:PO BOX 255747
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95865
Mailing Address - Country:US
Mailing Address - Phone:916-394-6555
Mailing Address - Fax:916-394-6545
Practice Address - Street 1:1810 PROFESSIONAL DRIVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825
Practice Address - Country:US
Practice Address - Phone:916-971-3461
Practice Address - Fax:916-973-9830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty