Provider Demographics
NPI:1134361157
Name:CAPITOL DENTAL INC.
Entity type:Organization
Organization Name:CAPITOL DENTAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:N
Authorized Official - Last Name:JONES
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-621-8000
Mailing Address - Street 1:1245 CAPITOL ST
Mailing Address - Street 2:SUITE 121-N
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-2847
Mailing Address - Country:US
Mailing Address - Phone:801-621-8000
Mailing Address - Fax:801-621-8001
Practice Address - Street 1:2717 N HWY 89 STE 100
Practice Address - Street 2:
Practice Address - City:PLEASANT VIEW
Practice Address - State:UT
Practice Address - Zip Code:84404-1230
Practice Address - Country:US
Practice Address - Phone:801-621-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT373461305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization