Organization
CAPITOL PERIODONTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RENEE BLAKE (INSURANCE SPECIALIST)
(916) 691-1050
Entity
Organization
Contact information
Practice address
2535 E BIDWELL ST STE 150, FOLSOM, CA 95630-6458
(916) 984-1109
(916) 984-1764
Mailing address
9309 OFFICE PARK CIR STE 120, ELK GROVE, CA 95758-8072
(916) 691-1050
(916) 691-1066
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
22639744
CA
Other
Enumeration date
09/09/2009
Last updated
09/09/2009
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