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General NPI Number Information
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NPI Number | 1962073841
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Entity Type | Individual
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Provider Name | KIM ROOPRAI
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Gender | Female
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Dates
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Enumeration Date | 07/01/2021
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 301 PROSPECT AVE
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City | SYRACUSE
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State | NY
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Zip | 13203-1807
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Country | US
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Telephone | 315-448-5111
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Fax |
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Provider Business Mailing Address
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Address Line | 109 S WARREN ST APT 809
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City | SYRACUSE
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State | NY
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Zip | 13202-5008
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Country | US
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Telephone | 416-873-5088
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.034636
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 062645
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License Number State | NY
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