Provider Demographics
NPI:1255543328
Name:GUPTA, MANISHA (DMD)
Entity type:Individual
Prefix:DR
First Name:MANISHA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2047 ORCHARD MIST ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-1561
Mailing Address - Country:US
Mailing Address - Phone:702-202-8293
Mailing Address - Fax:
Practice Address - Street 1:7180 CASCADE VALLEY CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0449
Practice Address - Country:US
Practice Address - Phone:702-735-0833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5104122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist