NPIMap

Organization Active NPI

Capitol Periodontal Group

  • Periodontics
  • Davis, CA
National Provider Identifier
1366908618
Registry record updated Feb 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
Legal business name
CAPITOL PERIODONTAL GROUP
Practice address
750 F Street #5
Davis, CA 95616
Phone
(530) 756-6087
Fax
(530) 756-5688
NPI assigned
Feb 12, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Renee Blake
Title
Insurance Coordinator
Phone
(916) 691-1050

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0300X Primary

Addresses

Primary practice location

750 F Street #5
Davis, CA 95616

Mailing address

9309 Office Park Circle, Suite 120
Elk Grove, CA 95758
Phone (916) 691-1050

National Provider Directory

National Provider Directory
Tax ID family
Capitol Periodontal Group5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

750 F St
#5
Davis, CA 95616
Phone (530) 756-6087

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1549929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549929600000",
    "number": "1366908618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9309 OFFICE PARK CIRCLE, SUITE 120",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "95758",
            "telephone_number": "916-691-1050",
            "fax_number": "916-691-1066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 F STREET #5",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "95616",
            "telephone_number": "530-756-6087",
            "fax_number": "530-756-5688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAPITOL PERIODONTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-12",
        "last_updated": "2019-02-12",
        "status": "A",
        "authorized_official_last_name": "BLAKE",
        "authorized_official_first_name": "RENEE",
        "authorized_official_title_or_position": "INSURANCE COORDINATOR",
        "authorized_official_telephone_number": "916-691-1050"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Davis, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.