Provider Demographics
NPI:1609800762
Name:GUPTA, REENA (DDS)
Entity Type:Individual
Prefix:DR
First Name:REENA
Middle Name:
Last Name:GUPTA
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 1:373 S MONROE ST
Mailing Address - Street 2:ST 203
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-5103
Mailing Address - Country:US
Mailing Address - Phone:408-247-4100
Mailing Address - Fax:650-230-7114
Practice Address - Street 1:373 S MONROE ST
Practice Address - Street 2:ST 203
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-5103
Practice Address - Country:US
Practice Address - Phone:408-247-4100
Practice Address - Fax:650-230-7114
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA499671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice