Provider Demographics
NPI:1386606317
Name:WADHWA, RUPALI (DMD)
Entity type:Individual
Prefix:
First Name:RUPALI
Middle Name:
Last Name:WADHWA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:RUPALI
Other - Middle Name:
Other - Last Name:KAPUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:161 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-3772
Mailing Address - Country:US
Mailing Address - Phone:973-538-2171
Mailing Address - Fax:973-378-0288
Practice Address - Street 1:161 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960
Practice Address - Country:US
Practice Address - Phone:973-538-2171
Practice Address - Fax:973-378-0288
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0316391223X0400X
NJ22DI021882001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018485030006Medicaid
PA0018485030011Medicaid
PA0018485030012Medicaid
PA0018485030017Medicaid
PA0018485030019Medicaid
PA0018485030014Medicaid
PA0018485030013Medicaid
PA0018485030015Medicaid
PA0018485030016Medicaid
PA0018485030008Medicaid
PA0018485030010Medicaid
PA0018485030009Medicaid
PA0018485030007Medicaid