Provider Demographics
NPI:1316035090
Name:KAPADIA, SUKETU ANUPAM (DDS)
Entity Type:Individual
Prefix:
First Name:SUKETU
Middle Name:ANUPAM
Last Name:KAPADIA
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 1:6332 LAKE WORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76135-3602
Mailing Address - Country:US
Mailing Address - Phone:817-237-3222
Mailing Address - Fax:817-237-0101
Practice Address - Street 1:6332 LAKE WORTH BLVD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-3602
Practice Address - Country:US
Practice Address - Phone:817-237-3222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX199421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice