Healthcare Provider Details

I. General information

NPI: 1558626036
Provider Name (Legal Business Name): NATASHA KAPOOR D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 RIVER PLACE DR APT 5103
DETROIT MI
48207-5030
US

IV. Provider business mailing address

500 RIVER PLACE DRIVE APT 5103
DETROIT MI
48207
US

V. Phone/Fax

Practice location:
  • Phone: 313-338-3900
  • Fax:
Mailing address:
  • Phone: 313-338-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number055887
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: