| NPI | 1730737545 |
|---|---|
| Doing Business As | CAPITAL DISTRICT ORAL & MAXILLOFACIAL SURGEONS |
| Entity Type | Organization |
| Authorized Contact | LEAH ANN MAYLOTT Credentialing Administrator 860-874-8198 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2019-08-27 |
| Last Update Date | 2022-01-10 |