Provider Demographics
NPI:1639488869
Name:CAPITAL DENTAL CARE PLLC
Entity Type:Organization
Organization Name:CAPITAL DENTAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ALWAKFI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:518-459-2444
Mailing Address - Street 1:165 MANNING BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-1756
Mailing Address - Country:US
Mailing Address - Phone:518-459-2444
Mailing Address - Fax:518-459-2445
Practice Address - Street 1:165 MANNING BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-1756
Practice Address - Country:US
Practice Address - Phone:518-459-2444
Practice Address - Fax:518-459-2445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0468311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty