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Organization
CAPITOL DENTAL GROUP, LLC
Active
Organization
CAPITOL DENTAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBET MICHAEL JOHNSON D.M.D. (DENTIST)
(803) 252-4500
Entity
Organization
Contact information
Practice address
1106 ANTHONY AVE, COLUMBIA, SC 29201-1730
(803) 252-4500
(803) 252-0334
Mailing address
1106 ANTHONY AVE, COLUMBIA, SC 29201-1730
(803) 252-4500
(803) 252-0334
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
SC-2275
SC
261QD0000X
Dental Clinic/Center
SC-4484
SC
Other
Enumeration date
06/04/2009
Last updated
06/04/2009
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