Provider Demographics
NPI:1437468030
Name:GUPTA, RITU (MSD)
Entity Type:Individual
Prefix:DR
First Name:RITU
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 LITTLE ELM PKWY
Mailing Address - Street 2:SUITE 165
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068
Mailing Address - Country:US
Mailing Address - Phone:512-483-1442
Mailing Address - Fax:
Practice Address - Street 1:2705 LITTLE ELM PKWY
Practice Address - Street 2:SUITE 165
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068
Practice Address - Country:US
Practice Address - Phone:512-483-1442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL110861223X0400X
TX297541223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics