Provider Demographics
NPI:1558626036
Name:KAPOOR, NATASHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATASHA
Middle Name:
Last Name:KAPOOR
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 1:500 RIVER PLACE DRIVE
Mailing Address - Street 2:APT 5103
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207
Mailing Address - Country:US
Mailing Address - Phone:313-338-3900
Mailing Address - Fax:
Practice Address - Street 1:500 RIVER PLACE DR
Practice Address - Street 2:APT 5103
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-5030
Practice Address - Country:US
Practice Address - Phone:313-338-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0558871223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics