Healthcare Provider Details

I. General information

NPI: 1033064381
Provider Name (Legal Business Name): UPASANA MATHUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2760 MACK RD
FAIRFIELD OH
45014-5129
US

IV. Provider business mailing address

430 INDIANA AVE APT 204
INDIANAPOLIS IN
46202-3232
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-7433
  • Fax:
Mailing address:
  • Phone: 404-201-0798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.028548
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: