Provider Demographics
NPI:1356776611
Name:GUPTA, NEHA (DMD)
Entity type:Individual
Prefix:
First Name:NEHA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:NEHA
Other - Middle Name:
Other - Last Name:BANSAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10900 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-4905
Mailing Address - Country:US
Mailing Address - Phone:215-817-8873
Mailing Address - Fax:
Practice Address - Street 1:10900 EUCLID AVE
Practice Address - Street 2:CASE WESTERN RESERVE UNIV SCHOOL OF DENTAL MEDICINE
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-4905
Practice Address - Country:US
Practice Address - Phone:215-817-8873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0240551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice