MEDICARE: DR. KAPISH GOYAL D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	0401414746	VA

General Provider Information

NPI Number	:	1821302803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAPISH GOYAL D.D.S.

Provider Business Mailing Address
First Line	:	2109 MCCOMAS WAY STE 101
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-3909
Country	:	US
Telephone Number	:	757-427-0695
Fax Number	:	757-430-9341

Provider Business Practice Location Address
First Line	:	2109 MCCOMAS WAY STE 101
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-3909
Country	:	US
Telephone Number	:	757-427-0695
Fax Number	:	757-430-9341

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2010
Last Update Date	:	02/18/2021

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