NPI | 1831101518 |
---|---|
Former Legal Business Name | CAPITOL DENTAL |
Entity Type | Organization |
Authorized Contact | DARREL L MOONEY Owner 208-336-9333 |
Organization Subpart ? | No |
Primary Taxonomy | 122300000X Dentist |
Additional Taxonomies | 1223P0300X Dentist, Periodontics |
1223P0700X Dentist, Prosthodontics | |
Enumeration Date | 2006-08-12 |
Last Update Date | 2020-08-22 |