Provider Demographics
NPI:1730541061
Name:KAPOOR, RANDHIR (DDS, PHD)
Entity type:Individual
Prefix:
First Name:RANDHIR
Middle Name:
Last Name:KAPOOR
Suffix:
Gender:M
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1674 KELLER PKWY
Mailing Address - Street 2:160
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3751
Mailing Address - Country:US
Mailing Address - Phone:817-741-4867
Mailing Address - Fax:817-741-3333
Practice Address - Street 1:1674 KELLER PKWY
Practice Address - Street 2:160
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3751
Practice Address - Country:US
Practice Address - Phone:817-741-4867
Practice Address - Fax:817-741-3333
Is Sole Proprietor?:No
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX191551223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics