Provider Demographics
NPI:1225244700
Name:GUPTE, RENY MATHEW (DDS)
Entity Type:Individual
Prefix:DR
First Name:RENY
Middle Name:MATHEW
Last Name:GUPTE
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 1:901 COVERT AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-5401
Mailing Address - Country:US
Mailing Address - Phone:516-488-2614
Mailing Address - Fax:
Practice Address - Street 1:901 COVERT AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-5401
Practice Address - Country:US
Practice Address - Phone:516-488-2614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0454991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice