Healthcare Provider Details

I. General information

NPI: 1174743041
Provider Name (Legal Business Name): SHEKHAR GUPTA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112A N 9TH ST
STROUDSBURG PA
18360-1102
US

IV. Provider business mailing address

PO BOX 3189
SYRACUSE NY
13220-3189
US

V. Phone/Fax

Practice location:
  • Phone: 570-424-6005
  • Fax: 570-424-6534
Mailing address:
  • Phone: 315-454-6000
  • Fax: 315-454-8650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS036379
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: