# CAPITOL ENDODONTICS, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518330463
- **Authorized official:** AMANDA BOUSTANY D.D.S., M.S.D. (OWNER)
- **Authorized official phone:** (304) 345-1248

## Contact information

- **Practice address:** 405 CAPITOL ST, SUITE 914, CHARLESTON, WV 25301-1749
- **Practice address phone:** (304) 345-1248
- **Mailing address:** 405 CAPITOL ST, SUITE 914, CHARLESTON, WV 25301-1749
- **Mailing address phone:** (304) 345-1248

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | 4180 | WV | Yes |

## Other

- **Enumeration date:** 11/01/2015
- **Last updated:** 11/01/2015