Provider Demographics
NPI:1720008790
Name:GUPTA, NEIL KAMAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:KAMAL
Last Name:GUPTA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4281 BLUEBIRD DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-5406
Mailing Address - Country:US
Mailing Address - Phone:801-966-0914
Mailing Address - Fax:801-679-0666
Practice Address - Street 1:500 FOOTHILL BLVD
Practice Address - Street 2:DENTAL DEPARTMENT
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84148-0001
Practice Address - Country:US
Practice Address - Phone:801-966-0914
Practice Address - Fax:801-679-0666
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5542156-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice