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General NPI Number Information
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NPI Number | 1528785250
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Entity Type | Individual
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Provider Name | KRUPA BAMBAL
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Gender | Female
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Dates
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Enumeration Date | 10/24/2022
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 1402 ELLIS DR APT 1402
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City | GLEN MILLS
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State | PA
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Zip | 19342-3403
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Country | US
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Telephone | 484-714-5261
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Fax |
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Provider Business Mailing Address
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Address Line | 225 WILMINGTON W CHESTER PIKE STE 100
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City | CHADDS FORD
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State | PA
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Zip | 19317-9011
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Country | US
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Telephone | 427-148-4285
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 2901601536
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License Number State | MI
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