Provider Demographics
NPI:1003968611
Name:GUPTA, ANKUR AJAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANKUR
Middle Name:AJAY
Last Name:GUPTA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 PROSPECT AVE E APT 801
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-1170
Mailing Address - Country:US
Mailing Address - Phone:216-241-2978
Mailing Address - Fax:440-327-0027
Practice Address - Street 1:34100 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-5311
Practice Address - Country:US
Practice Address - Phone:440-327-0027
Practice Address - Fax:440-327-0027
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH220741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice