Provider Demographics
NPI:1316151798
Name:CAPITOL CENTER FOR ORAL & MAXILLOFACIAL SURGERY, PLLC
Entity type:Organization
Organization Name:CAPITOL CENTER FOR ORAL & MAXILLOFACIAL SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROSATO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-225-0008
Mailing Address - Street 1:6 LOUDON RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-5321
Mailing Address - Country:US
Mailing Address - Phone:603-225-0008
Mailing Address - Fax:603-225-8120
Practice Address - Street 1:129 WILTON RD
Practice Address - Street 2:SUITE B
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-1749
Practice Address - Country:US
Practice Address - Phone:603-784-5447
Practice Address - Fax:603-784-5449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3188204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH02Y002478NH02OtherANTHEM
NH30314308Medicaid
NH2027588OtherCIGNA HEALTHCARE
NH30314308Medicaid
NHRE6114Medicare ID - Type Unspecified