Provider Demographics
NPI:1053841908
Name:GUPTA, SHILPI (DDS)
Entity Type:Individual
Prefix:
First Name:SHILPI
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12120 LIESFELD POND DR
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-7094
Mailing Address - Country:US
Mailing Address - Phone:412-680-3891
Mailing Address - Fax:
Practice Address - Street 1:7522 LEE DAVIS RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-3603
Practice Address - Country:US
Practice Address - Phone:804-559-1016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401415668122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1053841908OtherNPI