Organization
CAPITOL ENDODONTICS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA BOUSTANY D.D.S., M.S.D. (OWNER)
(304) 345-1248
Entity
Organization
Contact information
Practice address
405 CAPITOL ST, SUITE 914, CHARLESTON, WV 25301-1749
(304) 345-1248
Mailing address
405 CAPITOL ST, SUITE 914, CHARLESTON, WV 25301-1749
(304) 345-1248
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
4180
WV
Other
Enumeration date
11/01/2015
Last updated
11/01/2015
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