Organization
DEBONAIR DENTAL DC PLLC
Active
Other names
Capitol Dental
Organization subpart
No
Provider details
NPI number
Authorized official
OTIS COLLINS (COO)
(202) 232-1116
Entity
Organization
Contact information
Practice address
2737 DEVONSHIRE PL NW STE A, WASHINGTON, DC 20008-3479
(202) 232-1116
(202) 232-1911
Mailing address
2737 DEVONSHIRE PL NW STE A, WASHINGTON, DC 20008-3479
(202) 232-1116
(202) 232-1911
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
124Q00000X
Dental Hygienist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DEN1001405
DOH HEALTH REGULATION AND LICENSING ADMINISTRATION BOARD OF DENTISTRY
DC
Enumeration date
06/17/2019
Last updated
06/17/2019
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