Healthcare Provider Details

I. General information

NPI: 1356774954
Provider Name (Legal Business Name): AKANKSHA GUPTA BDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2013
Last Update Date: 11/01/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 BOREN AVENUE SUITE #1776
SEATTLE WA
98104
US

IV. Provider business mailing address

901 BOREN AVENUE SUITE #1776
SEATTLE WA
98104
US

V. Phone/Fax

Practice location:
  • Phone: 206-363-8240
  • Fax: 206-363-8301
Mailing address:
  • Phone: 206-363-8240
  • Fax: 206-363-8301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License NumberDE60807266
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberR580
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: