Provider Demographics
NPI:1730306325
Name:UPTON, MIN GU (DDS)
Entity Type:Individual
Prefix:
First Name:MIN
Middle Name:GU
Last Name:UPTON
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 1:2806 ESTURION CT
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-4415
Mailing Address - Country:US
Mailing Address - Phone:760-476-9736
Mailing Address - Fax:
Practice Address - Street 1:240 W MISSION AVE
Practice Address - Street 2:SUITES A & B
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-1700
Practice Address - Country:US
Practice Address - Phone:760-747-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA439641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice