Provider Demographics
NPI:1659028801
Name:CAPITOL DENTAL CENTER PLC
Entity Type:Organization
Organization Name:CAPITOL DENTAL CENTER PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SCHAFHAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:612-222-1201
Mailing Address - Street 1:444 CEDAR ST STE 206
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2187
Mailing Address - Country:US
Mailing Address - Phone:651-222-1201
Mailing Address - Fax:651-760-8633
Practice Address - Street 1:444 CEDAR ST STE 206
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2187
Practice Address - Country:US
Practice Address - Phone:651-222-1201
Practice Address - Fax:651-760-8633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-08
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty