Provider Demographics
NPI:1548304983
Name:KRISTNA KAPUR, DDS & LUIS T MAULEON JR, DDS, PC
Entity type:Organization
Organization Name:KRISTNA KAPUR, DDS & LUIS T MAULEON JR, DDS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:THELMO
Authorized Official - Last Name:MAULEON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:607-272-8118
Mailing Address - Street 1:501 N CAYUGA ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-3670
Mailing Address - Country:US
Mailing Address - Phone:607-272-8118
Mailing Address - Fax:607-272-4114
Practice Address - Street 1:501 N CAYUGA ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-3670
Practice Address - Country:US
Practice Address - Phone:607-272-8118
Practice Address - Fax:607-272-4114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty