Provider Demographics
NPI:1225109192
Name:KAPUR, SIMMI (DDS)
Entity Type:Individual
Prefix:DR
First Name:SIMMI
Middle Name:
Last Name:KAPUR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EQUESTRIAN WAY
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-9786
Mailing Address - Country:US
Mailing Address - Phone:708-699-3775
Mailing Address - Fax:708-425-5315
Practice Address - Street 1:4934 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2504
Practice Address - Country:US
Practice Address - Phone:708-425-1811
Practice Address - Fax:708-425-5315
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019025356122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist