Healthcare Provider Details

I. General information

NPI: 1043488117
Provider Name (Legal Business Name): ARUN KUMAR GUPTA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11623 CHERRY AVE STE B2
FONTANA CA
92337-1212
US

IV. Provider business mailing address

3228 OCTOBER CT
RIVERSIDE CA
92503-0908
US

V. Phone/Fax

Practice location:
  • Phone: 909-355-1485
  • Fax: 909-355-2715
Mailing address:
  • Phone: 951-278-1931
  • Fax: 909-355-2715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number56817
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: