Provider Demographics
NPI:1184928640
Name:GUPTA, AVIN (DMD)
Entity type:Individual
Prefix:DR
First Name:AVIN
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 1:73 VISCOUNT DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14221-1766
Mailing Address - Country:US
Mailing Address - Phone:267-984-0145
Mailing Address - Fax:
Practice Address - Street 1:2800 SPENCERPORT RD
Practice Address - Street 2:SUITE A4
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-1977
Practice Address - Country:US
Practice Address - Phone:585-352-3627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0553231223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry