| Capitol Periodontal Group | |
|
750 F Street #5 Davis CA 95616 | |
| (530) 756-6087 | |
| (530) 756-5688 |
| Full Name | Capitol Periodontal Group |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 750 F Street #5, Davis, California |
| Authorized Official Name and Position | Renee Blake (INSURANCE COORDINATOR) |
| Authorized Official Contact | 9166911050 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Capitol Periodontal Group 9309 Office Park Circle, Suite 120 Elk Grove CA 95758 Ph: (916) 691-1050 | Capitol Periodontal Group 750 F Street #5 Davis CA 95616 Ph: (530) 756-6087 |
| NPI Number | 1366908618 |
|---|---|
| Provider Enumeration Date | 02/12/2019 |
| Last Update Date | 02/12/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366908618 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | (* (Not Available)) | Primary |
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