Provider Demographics
NPI:1164653366
Name:SOM N. GUPTA D.D.S.P.C.
Entity Type:Organization
Organization Name:SOM N. GUPTA D.D.S.P.C.
Other - Org Name:VERONA DENTAL CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SOM
Authorized Official - Middle Name:N
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:412-828-1920
Mailing Address - Street 1:625 ALLEGHENY RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:PA
Mailing Address - Zip Code:15147-1201
Mailing Address - Country:US
Mailing Address - Phone:412-828-1920
Mailing Address - Fax:412-828-8989
Practice Address - Street 1:625 ALLEGHENY RIVER BLVD
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:PA
Practice Address - Zip Code:15147-1201
Practice Address - Country:US
Practice Address - Phone:412-828-1920
Practice Address - Fax:412-828-8989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020601L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty