Organization
CAPITOL PERIODONTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN DILWORTH (FINANCIAL ASSISTANT)
(916) 394-6555
Entity
Organization
Contact information
Practice address
9309 OFFICE PARK CIR, STE 110, ELK GROVE, CA 95758-8072
(916) 684-3379
(916) 684-4106
Mailing address
PO BOX 255747, SACRAMENTO, CA 95865-5747
(916) 394-6555
(916) 394-6545
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Enumeration date
08/16/2007
Last updated
08/16/2007
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