Healthcare Provider Details

I. General information

NPI: 1184852147
Provider Name (Legal Business Name): ABHISHEK KAPOOR D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2009
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191, SOCIAL STREET,
WOONSOCKET RI
02895-3207
US

IV. Provider business mailing address

55 CLEAR POND DR UNIT #22-3,
WALPOLE MA
02081-4342
US

V. Phone/Fax

Practice location:
  • Phone: 401-767-4100
  • Fax:
Mailing address:
  • Phone: 732-996-7964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN 03256
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: