Provider Demographics
NPI:1184852147
Name:KAPOOR, ABHISHEK (DDS)
Entity Type:Individual
Prefix:DR
First Name:ABHISHEK
Middle Name:
Last Name:KAPOOR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 CLEAR POND DR
Mailing Address - Street 2:UNIT #22-3,
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-4342
Mailing Address - Country:US
Mailing Address - Phone:732-996-7964
Mailing Address - Fax:
Practice Address - Street 1:191, SOCIAL STREET,
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-3207
Practice Address - Country:US
Practice Address - Phone:401-767-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN 03256122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0347648Medicaid