Provider Demographics
NPI:1770082125
Name:CAPITOL ORAL, FACIAL & IMPLANT SURGERY PLLC
Entity type:Organization
Organization Name:CAPITOL ORAL, FACIAL & IMPLANT SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:202-716-7626
Mailing Address - Street 1:1325 18TH ST NW STE 203
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-6501
Mailing Address - Country:US
Mailing Address - Phone:202-716-7626
Mailing Address - Fax:
Practice Address - Street 1:1325 18TH ST NW STE 203
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-6501
Practice Address - Country:US
Practice Address - Phone:202-716-7626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty