Provider Demographics
NPI:1669877270
Name:CAPITAL DENTAL
Entity type:Organization
Organization Name:CAPITAL DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTURIST
Authorized Official - Prefix:
Authorized Official - First Name:RODRIGO
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTANO
Authorized Official - Suffix:
Authorized Official - Credentials:LD
Authorized Official - Phone:971-388-7725
Mailing Address - Street 1:4918 TURQUOISE AVE SE
Mailing Address - Street 2:APT D-304
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97317-4104
Mailing Address - Country:US
Mailing Address - Phone:971-388-7725
Mailing Address - Fax:
Practice Address - Street 1:408 LANCASTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4728
Practice Address - Country:US
Practice Address - Phone:503-362-3032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10150616261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental