Provider Demographics
NPI:1154487924
Name:UPPAL, GAGAN (DMD)
Entity Type:Individual
Prefix:
First Name:GAGAN
Middle Name:
Last Name:UPPAL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 TANTUM CT
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-4453
Mailing Address - Country:US
Mailing Address - Phone:609-668-9474
Mailing Address - Fax:908-753-9101
Practice Address - Street 1:4917 STELTON RD
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-1113
Practice Address - Country:US
Practice Address - Phone:908-753-9901
Practice Address - Fax:908-753-9101
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1022341001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice