Provider Demographics
NPI:1154632354
Name:KAPADIA, KAUSHAL PRAVIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KAUSHAL
Middle Name:PRAVIN
Last Name:KAPADIA
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 1:712 WYNCROFT TER
Mailing Address - Street 2:APT 4
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-6968
Mailing Address - Country:US
Mailing Address - Phone:443-481-7743
Mailing Address - Fax:
Practice Address - Street 1:712 WYNCROFT TER
Practice Address - Street 2:APT 4
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-6968
Practice Address - Country:US
Practice Address - Phone:443-481-7743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2012-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14528122300000X
PADS038321122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist