Provider Demographics
NPI:1912427766
Name:GUPTA, PRATIK VINODKUMAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:PRATIK
Middle Name:VINODKUMAR
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 1:202 W NC HIGHWAY 54 STE 201
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-7564
Mailing Address - Country:US
Mailing Address - Phone:919-225-2016
Mailing Address - Fax:919-590-1711
Practice Address - Street 1:202 W NC HIGHWAY 54 STE 201
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-7564
Practice Address - Country:US
Practice Address - Phone:919-205-2216
Practice Address - Fax:919-590-1711
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001615122300000X
NC11217122300000X
CA105850122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist