Provider Demographics
NPI:1114189891
Name:KAPUR, RISHI R (DMD)
Entity Type:Individual
Prefix:DR
First Name:RISHI
Middle Name:R
Last Name:KAPUR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4150 FIVE FORKS TRICKUM RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047
Mailing Address - Country:US
Mailing Address - Phone:770-717-7225
Mailing Address - Fax:770-717-7228
Practice Address - Street 1:4150 FIVE FORKS TRICKUM RD
Practice Address - Street 2:SUITE 1
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047
Practice Address - Country:US
Practice Address - Phone:770-717-7225
Practice Address - Fax:770-717-7228
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013767122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist