NPIMap

Organization Active NPI

Capitol Periodontal Group

  • Periodontics
  • Folsom, CA
National Provider Identifier
1962735993
Registry record updated Sep 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
22639744 Issued in CA
Legal business name
CAPITOL PERIODONTAL GROUP
Practice address
2535 E Bidwell St Ste 150
Folsom, CA 95630-6458
Phone
(916) 984-1109
Fax
(916) 984-1764
NPI assigned
Sep 9, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2009

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

Authorized official

Name
Mrs. Renee Blake
Title
Insurance Specialist
Phone
(916) 691-1050

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0300X 22639744 CA Primary

Addresses

Primary practice location

2535 E Bidwell St Ste 150
Folsom, CA 95630-6458

Mailing address

9309 Office Park Cir Ste 120
Elk Grove, CA 95758-8072
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

9309 Office Park Cir
Ste 120
Elk Grove, CA 95758
Phone (916) 236-3131

2535 E Bidwell St
Ste 150
Folsom, CA 95630
Phone (916) 984-1109

Practitioners & affiliated clinicians

Practitioners 9

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": "1252454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1252454400000",
    "number": "1962735993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9309 OFFICE PARK CIR STE 120",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957588072",
            "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": "2535 E BIDWELL ST STE 150",
            "city": "FOLSOM",
            "state": "CA",
            "postal_code": "956306458",
            "telephone_number": "916-984-1109",
            "fax_number": "916-984-1764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAPITOL PERIODONTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-09",
        "last_updated": "2009-09-09",
        "status": "A",
        "authorized_official_last_name": "BLAKE",
        "authorized_official_first_name": "RENEE",
        "authorized_official_title_or_position": "INSURANCE SPECIALIST",
        "authorized_official_telephone_number": "916-691-1050",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "22639744",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Folsom, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2009; 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.