Provider Demographics
NPI:1770629024
Name:GUPTA, NISHA PUNJABI (DDS)
Entity type:Individual
Prefix:
First Name:NISHA
Middle Name:PUNJABI
Last Name:GUPTA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35201 EMORY DR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-4932
Mailing Address - Country:US
Mailing Address - Phone:734-417-2781
Mailing Address - Fax:440-327-1326
Practice Address - Street 1:34100 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-5311
Practice Address - Country:US
Practice Address - Phone:440-327-0027
Practice Address - Fax:440-327-0027
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0220751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice