Provider Demographics
NPI:1952785859
Name:TINA GUPTA DDS PA
Entity Type:Organization
Organization Name:TINA GUPTA DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:252-572-2520
Mailing Address - Street 1:700 EXPOSITION PL
Mailing Address - Street 2:STE 111
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-1560
Mailing Address - Country:US
Mailing Address - Phone:919-518-0400
Mailing Address - Fax:919-518-0410
Practice Address - Street 1:700 EXPOSITION PL
Practice Address - Street 2:STE 111
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-1560
Practice Address - Country:US
Practice Address - Phone:919-518-0400
Practice Address - Fax:919-518-0410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC83001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty