Provider Demographics
NPI:1568864718
Name:CAPITAL DENTAL INC
Entity Type:Organization
Organization Name:CAPITAL DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:TIPTON
Authorized Official - Last Name:BUFORD
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-667-8818
Mailing Address - Street 1:1209 U ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-4442
Mailing Address - Country:US
Mailing Address - Phone:202-667-8818
Mailing Address - Fax:202-667-1024
Practice Address - Street 1:1209 U ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-4442
Practice Address - Country:US
Practice Address - Phone:202-667-8818
Practice Address - Fax:202-667-1024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN4056122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC016809400Medicaid