Provider Demographics
NPI:1770601841
Name:CAPITOL CLINICAL DENTAL SERVICES, PLLC
Entity type:Organization
Organization Name:CAPITOL CLINICAL DENTAL SERVICES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:AVA
Authorized Official - Last Name:MCCOY-COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-232-1116
Mailing Address - Street 1:2737 DEVONSHIRE PL NW STE A
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-3479
Mailing Address - Country:US
Mailing Address - Phone:202-232-1116
Mailing Address - Fax:202-232-1911
Practice Address - Street 1:2737 DEVONSHIRE PL NW STE A
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-3479
Practice Address - Country:US
Practice Address - Phone:202-232-1116
Practice Address - Fax:202-232-1911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN36521223S0112X, 261QD0000X
DCDEN100003801223S0112X
DCDEN10006251223S0112X
DCDEN10002901223G0001X
DCDEN40581223P0221X
DCDEN10000021223P0700X
DCDEN10006171223G0001X
DCDEN57241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC038965400Medicaid