Provider Demographics
NPI:1013050426
Name:GUPTA, SAREETA RANI (DDS)
Entity Type:Individual
Prefix:
First Name:SAREETA
Middle Name:RANI
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 1:4301 CONNECTICUT AVE NW
Mailing Address - Street 2:SUITE 139
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-2304
Mailing Address - Country:US
Mailing Address - Phone:202-244-4010
Mailing Address - Fax:
Practice Address - Street 1:4301 CONNECTICUT AVE NW
Practice Address - Street 2:SUITE 139
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-2304
Practice Address - Country:US
Practice Address - Phone:202-244-4010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN10002251223G0001X
MD129561223G0001X
VA0401411944122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist