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General NPI Number Information
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NPI Number | 1043443559
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Entity Type | Organization
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Legal Business Name | GUPTA DENTAL OFFICE
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Dates
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Enumeration Date | 08/31/2009
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Last Update Date | 08/31/2009
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Provider Practice Location Address
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Address Line | 16049 BASELINE AVE UNIT 3
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City | FONTANA
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State | CA
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Zip | 92336-1861
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Country | US
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Telephone | 909-356-9752
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Fax |
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Provider Business Mailing Address
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Address Line | 16049 BASELINE AVE UNIT 3
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City | FONTANA
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State | CA
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Zip | 92336-1861
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Country | US
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Telephone | 909-356-9752
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Fax |
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Authorized Official
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Title or Position | DENTIST / OWNER
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Name | DR. JUGAL K GUPTA
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Credential | DDS
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Telephone | 909-356-9752
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 36370
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License Number State | CA
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