Provider Demographics
NPI:1851528939
Name:GUPTA SUD, SABINA (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:SABINA
Middle Name:
Last Name:GUPTA SUD
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:DR
Other - First Name:SABINA
Other - Middle Name:
Other - Last Name:GUPTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD, MS
Mailing Address - Street 1:301 WASHINGTON ST STE B
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2914
Mailing Address - Country:US
Mailing Address - Phone:707-658-2320
Mailing Address - Fax:707-762-5149
Practice Address - Street 1:301 WASHINGTON ST STE B
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2914
Practice Address - Country:US
Practice Address - Phone:707-658-2320
Practice Address - Fax:707-762-5149
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64213122300000X
GADN013884122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist