Provider Demographics
NPI:1821229808
Name:GUPTA, DEEPAK (DMD)
Entity Type:Individual
Prefix:
First Name:DEEPAK
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 E 31ST ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401-7304
Mailing Address - Country:US
Mailing Address - Phone:912-232-2779
Mailing Address - Fax:912-236-1962
Practice Address - Street 1:207 E 31ST ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-7304
Practice Address - Country:US
Practice Address - Phone:912-232-2779
Practice Address - Fax:912-236-1962
Is Sole Proprietor?:No
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0139671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice