Provider Demographics
NPI:1902042716
Name:CAPITAL CITY ORAL SURGERY, PA
Entity Type:Organization
Organization Name:CAPITAL CITY ORAL SURGERY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:CRITTENDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:785-273-9717
Mailing Address - Street 1:2445 SW WANAMAKER RD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-5470
Mailing Address - Country:US
Mailing Address - Phone:785-273-9717
Mailing Address - Fax:
Practice Address - Street 1:2445 SW WANAMAKER RD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-5470
Practice Address - Country:US
Practice Address - Phone:785-273-9717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS606031223S0112X, 302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No302F00000XManaged Care OrganizationsExclusive Provider OrganizationGroup - Single Specialty