Provider Demographics
NPI:1720138977
Name:CAPATI DENTAL, LLC
Entity Type:Organization
Organization Name:CAPATI DENTAL, LLC
Other - Org Name:CAPITAL THREE, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:CDPMA
Authorized Official - Phone:217-522-4451
Mailing Address - Street 1:1027 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-3004
Mailing Address - Country:US
Mailing Address - Phone:217-522-4451
Mailing Address - Fax:217-522-3980
Practice Address - Street 1:1027 S 2ND ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-3004
Practice Address - Country:US
Practice Address - Phone:217-522-4451
Practice Address - Fax:217-522-3980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental