Provider Demographics
NPI:1629451430
Name:CAPITAL KIDS DENTISTRY LLC
Entity Type:Organization
Organization Name:CAPITAL KIDS DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:EXELBERT
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-545-7200
Mailing Address - Street 1:4200 WISCONSIN AVE NW STE 240
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-2143
Mailing Address - Country:US
Mailing Address - Phone:202-545-7200
Mailing Address - Fax:
Practice Address - Street 1:4200 WISCONSIN AVE NW STE 240
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2143
Practice Address - Country:US
Practice Address - Phone:202-545-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-30
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN10008641223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty