Provider Demographics
NPI:1235717570
Name:GUPTA FAMILY DENTISTRY PLLC
Entity Type:Organization
Organization Name:GUPTA FAMILY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BHUMIJA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-436-1640
Mailing Address - Street 1:PO BOX 455
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:NY
Mailing Address - Zip Code:14506-0455
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 ASSEMBLY DR STE 101
Practice Address - Street 2:
Practice Address - City:MENDON
Practice Address - State:NY
Practice Address - Zip Code:14506-9604
Practice Address - Country:US
Practice Address - Phone:585-624-5480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GUPTA FAMILY DENTISTRY PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty