Healthcare Provider Details

I. General information

NPI: 1881248730
Provider Name (Legal Business Name): SUCHIT KAPUR DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12750 CARMEL COUNTRY RD STE 205
SAN DIEGO CA
92130-2171
US

IV. Provider business mailing address

8793 LIGHTWAVE AVE APT C353
SAN DIEGO CA
92123-5016
US

V. Phone/Fax

Practice location:
  • Phone: 858-481-1148
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number104066
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS104066
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: