Healthcare Provider Details

I. General information

NPI: 1336430487
Provider Name (Legal Business Name): SAROJ GUPTA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2011
Last Update Date: 08/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 W BALTIMORE ST
BALTIMORE MD
21201-1510
US

IV. Provider business mailing address

650 W BALTIMORE ST
BALTIMORE MD
21201-1510
US

V. Phone/Fax

Practice location:
  • Phone: 913-706-0401
  • Fax: 410-706-6115
Mailing address:
  • Phone: 913-706-0401
  • Fax: 410-706-6115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number76
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: