Provider Demographics
NPI:1487214607
Name:KAPOOR AND RAVI DMD LLC
Entity Type:Organization
Organization Name:KAPOOR AND RAVI DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KSHITIJ
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPOOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-204-4494
Mailing Address - Street 1:12300 S SHORE BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6509
Mailing Address - Country:US
Mailing Address - Phone:561-204-4494
Mailing Address - Fax:
Practice Address - Street 1:12300 S SHORE BLVD STE 208
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6509
Practice Address - Country:US
Practice Address - Phone:561-204-4494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-19
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental