Provider Demographics
NPI:1184775363
Name:GUPTA, CHANDER (DDS)
Entity type:Individual
Prefix:DR
First Name:CHANDER
Middle Name:
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 1:129 E DANIA BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:DANIA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33004-3032
Mailing Address - Country:US
Mailing Address - Phone:954-922-4633
Mailing Address - Fax:954-921-5999
Practice Address - Street 1:129 E DANIA BEACH BLVD
Practice Address - Street 2:
Practice Address - City:DANIA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33004-3032
Practice Address - Country:US
Practice Address - Phone:954-922-4633
Practice Address - Fax:954-921-5999
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10515122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
714891OtherUNITED CONCORDIA