Provider Demographics
NPI:1649702440
Name:CAPITAL DME
Entity type:Organization
Organization Name:CAPITAL DME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUWOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:AJAGBE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-239-7108
Mailing Address - Street 1:3636 16TH ST NW
Mailing Address - Street 2:SUITE AG 13
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-1146
Mailing Address - Country:US
Mailing Address - Phone:202-239-7108
Mailing Address - Fax:
Practice Address - Street 1:3636 16TH ST NW
Practice Address - Street 2:SUITE AG 13
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-1146
Practice Address - Country:US
Practice Address - Phone:202-239-7108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CREATIVE SMILE INSTITUTE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC5263261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC01801200Medicaid