| Capitol Dental Group, Llc | |
|
1106 Anthony Ave Columbia SC 29201-1730 | |
| (803) 252-4500 | |
| (803) 252-0334 |
| Full Name | Capitol Dental Group, Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1106 Anthony Ave, Columbia, South Carolina |
| Authorized Official Name and Position | Robet Michael Johnson (DENTIST) |
| Authorized Official Contact | 8032524500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Capitol Dental Group, Llc 1106 Anthony Ave Columbia SC 29201-1730 Ph: (803) 252-4500 | Capitol Dental Group, Llc 1106 Anthony Ave Columbia SC 29201-1730 Ph: (803) 252-4500 |
| NPI Number | 1295961274 |
|---|---|
| Provider Enumeration Date | 06/04/2009 |
| Last Update Date | 06/04/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295961274 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | SC-2275 (South Carolina) | Primary |
| 261QD0000X | Clinic/center - Dental | SC-4484 (South Carolina) | Secondary |
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