Provider Demographics
NPI:1780737627
Name:GUPTA, NIDHI (DMD)
Entity type:Individual
Prefix:DR
First Name:NIDHI
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 1:2340 E MEYER BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64132-1121
Mailing Address - Country:US
Mailing Address - Phone:802-851-8603
Mailing Address - Fax:802-851-8313
Practice Address - Street 1:1050 W BLUE RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64145-1216
Practice Address - Country:US
Practice Address - Phone:913-669-6129
Practice Address - Fax:913-281-6405
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20190022941223G0001X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1014638Medicaid
KS30004631500002Medicaid
ME432249499Medicaid
MO1780737627OtherNPI
VT47D0660981Medicaid
MO400071252Medicaid