Organization
CAPITOL PERIODONTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RENEE BLAKE (INSURANCE COORDINATOR)
(916) 691-1050
Entity
Organization
Contact information
Practice address
750 F STREET #5, DAVIS, CA 95616
(530) 756-6087
(530) 756-5688
Mailing address
9309 OFFICE PARK CIRCLE, SUITE 120, ELK GROVE, CA 95758
(916) 691-1050
(916) 691-1066
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Enumeration date
02/12/2019
Last updated
02/12/2019
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