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General NPI Number Information
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NPI Number | 1619021490
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Entity Type | Organization
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Legal Business Name | ARIZONA PEDIATRIC DENTISTRY AND ORTHODONTIC
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4145 N 108TH AVE BLDG K-101
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City | PHOENIX
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State | AZ
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Zip | 85037-5463
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Country | US
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Telephone | 623-344-2000
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Fax | 623-344-2007
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Provider Business Mailing Address
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Address Line | 4145 N 108TH AVE BLDG K-101
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City | PHOENIX
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State | AZ
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Zip | 85037-5463
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Country | US
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Telephone | 623-344-2000
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Fax | 623-344-2007
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Authorized Official
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Title or Position | OWNER
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Name | SHASHI M. KAPUR
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Credential | D.D.S.
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Telephone | 623-344-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D3801
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License Number State | AZ
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