Provider Demographics
NPI:1326558750
Name:GUPTA, TRIPTI (DMD)
Entity Type:Individual
Prefix:DR
First Name:TRIPTI
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12451 MAIN CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-8642
Mailing Address - Country:US
Mailing Address - Phone:857-277-4058
Mailing Address - Fax:
Practice Address - Street 1:314 MOODY ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-5202
Practice Address - Country:US
Practice Address - Phone:781-398-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18577921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice