Provider Demographics
NPI:1669489316
Name:GUPTA, SOM NATH (DDS)
Entity type:Individual
Prefix:
First Name:SOM
Middle Name:NATH
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 1:625 ALLEGHENY RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:PA
Mailing Address - Zip Code:15147-1201
Mailing Address - Country:US
Mailing Address - Phone:412-828-1920
Mailing Address - Fax:412-828-8989
Practice Address - Street 1:625 ALLEGHENY RIVER BLVD
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:PA
Practice Address - Zip Code:15147-1201
Practice Address - Country:US
Practice Address - Phone:412-828-1920
Practice Address - Fax:412-828-8989
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020601L122300000X
CA52239122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist