Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | D3801 | AZ |
NPI | 1083770614 |
---|---|
Provider Name | Dr. Shashi Mohan Kapur |
First Address | Chandler, AZ 85224 |
Second Address | Chandler, AZ 85224 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
091687 | ACCCHS (01) | AZ |