Provider Demographics
NPI:1386835296
Name:BANSAL, SHUCHITA GUPTA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHUCHITA
Middle Name:GUPTA
Last Name:BANSAL
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 1:17832 BELLFLOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-6614
Mailing Address - Country:US
Mailing Address - Phone:562-644-5771
Mailing Address - Fax:
Practice Address - Street 1:17832 BELLFLOWER BLVD
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-6614
Practice Address - Country:US
Practice Address - Phone:562-920-3400
Practice Address - Fax:562-920-3444
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55506122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist