Provider Demographics
NPI:1164034369
Name:VIRDI, RENU KAPOOR (DDS)
Entity Type:Individual
Prefix:
First Name:RENU
Middle Name:KAPOOR
Last Name:VIRDI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:RENU
Other - Middle Name:
Other - Last Name:KAPOOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:15709 GREYTHORNE DR APT 209
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-4744
Mailing Address - Country:US
Mailing Address - Phone:404-834-2144
Mailing Address - Fax:
Practice Address - Street 1:9709 REDSTONE DR
Practice Address - Street 2:STE 500
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707
Practice Address - Country:US
Practice Address - Phone:803-753-1349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC96661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice