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General NPI Number Information
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NPI Number | 1225213176
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Entity Type | Organization
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Legal Business Name | VANDE MATRAM PERIODONTOLOGY, PA
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Dates
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Enumeration Date | 01/09/2008
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Last Update Date | 01/09/2008
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Provider Practice Location Address
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Address Line | 1674 KELLER PKWY # 160
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City | KELLER
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State | TX
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Zip | 76248-3751
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Country | US
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Telephone | 817-741-4867
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Fax | 817-741-3333
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Provider Business Mailing Address
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Address Line | 1674 KELLER PKWY # 160
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City | KELLER
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State | TX
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Zip | 76248-3751
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Country | US
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Telephone | 817-741-4867
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Fax | 817-741-3333
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Authorized Official
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Title or Position | PERIODONTIST
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Name | DR. RANDHIR KUMAR KAPOOR
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Credential | DDS, PHD.
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Telephone | 817-741-4867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 19155
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License Number State | TX
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