Provider Demographics
NPI:1609214204
Name:GAGAN UPPAL DDS CORPORATION
Entity Type:Organization
Organization Name:GAGAN UPPAL DDS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:
Authorized Official - First Name:GAGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:UPPAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-262-0300
Mailing Address - Street 1:5405 ALTON PKWY STE F
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-3719
Mailing Address - Country:US
Mailing Address - Phone:949-262-0300
Mailing Address - Fax:949-262-0303
Practice Address - Street 1:5405 ALTON PKWY STE F
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-3719
Practice Address - Country:US
Practice Address - Phone:949-262-0300
Practice Address - Fax:949-262-0303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55640261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental