Provider Demographics
NPI:1841489291
Name:KAPOOR, ELLENI KAUR (DDS)
Entity type:Individual
Prefix:DR
First Name:ELLENI
Middle Name:KAUR
Last Name:KAPOOR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ELLENI
Other - Middle Name:KAUR
Other - Last Name:KAPOOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1544 LASKIN RD STE 226
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-7502
Mailing Address - Country:US
Mailing Address - Phone:757-965-3333
Mailing Address - Fax:757-965-3335
Practice Address - Street 1:1544 LASKIN RD STE 226
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-7502
Practice Address - Country:US
Practice Address - Phone:757-965-3333
Practice Address - Fax:757-965-3335
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX233901223G0001X
VA04014139541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1841489291Medicaid