Provider Demographics
NPI:1780391425
Name:PRIYA GUPTA DDS PC
Entity type:Organization
Organization Name:PRIYA GUPTA DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:703-609-4144
Mailing Address - Street 1:12380 CLARETH DR
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-2015
Mailing Address - Country:US
Mailing Address - Phone:703-609-4144
Mailing Address - Fax:
Practice Address - Street 1:4001 LEGATO RD STE 203
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-4098
Practice Address - Country:US
Practice Address - Phone:703-385-7177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-02
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty