Provider Demographics
NPI:1790905230
Name:JANI, KRUPA (DMD)
Entity Type:Individual
Prefix:DR
First Name:KRUPA
Middle Name:
Last Name:JANI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3613 EAGLE POINT LN
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-7395
Mailing Address - Country:US
Mailing Address - Phone:199-359-7439
Mailing Address - Fax:866-570-5630
Practice Address - Street 1:3001 RALEIGH ROAD PKWY W STE B
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-8213
Practice Address - Country:US
Practice Address - Phone:252-293-4469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC127941223G0001X, 1223P0221X
IL019027091122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist