Healthcare Provider Details

I. General information

NPI: 1568230894
Provider Name (Legal Business Name): SEJAL GUPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2023
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

377 S ILLINOIS AVE
OAK RIDGE TN
37830-6741
US

IV. Provider business mailing address

377 S ILLINOIS AVE
OAK RIDGE TN
37830-6741
US

V. Phone/Fax

Practice location:
  • Phone: 865-272-2633
  • Fax:
Mailing address:
  • Phone: 865-272-2633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13224
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: