Provider Demographics
NPI:1891848958
Name:SHASHI M. KAPUR
Entity Type:Organization
Organization Name:SHASHI M. KAPUR
Other - Org Name:ARIZONA PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHASHI
Authorized Official - Middle Name:M
Authorized Official - Last Name:KAPUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-820-6778
Mailing Address - Street 1:600 S DOBSON RD
Mailing Address - Street 2:STE. C-18
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5678
Mailing Address - Country:US
Mailing Address - Phone:480-820-6778
Mailing Address - Fax:480-820-3606
Practice Address - Street 1:600 S DOBSON RD
Practice Address - Street 2:STE. C-18
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5678
Practice Address - Country:US
Practice Address - Phone:480-820-6778
Practice Address - Fax:480-820-3606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD38011223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZF00359Medicaid