Healthcare Provider Details

I. General information

NPI: 1093007791
Provider Name (Legal Business Name): DEEPAK KUMAR GUPTA D.M.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 05/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5961 N DALLAS PKWY SUITE 601
PLANO TX
75093-7899
US

IV. Provider business mailing address

5961 N DALLAS PKWY SUITE 601
PLANO TX
75093-7899
US

V. Phone/Fax

Practice location:
  • Phone: 972-473-3000
  • Fax:
Mailing address:
  • Phone: 972-473-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number26417
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: