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General NPI Number Information
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NPI Number | 1144658360
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Entity Type | Individual
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Provider Name | SHAILY GUPTA D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 10/25/2013
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Last Update Date | 07/25/2017
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Provider Practice Location Address
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Address Line | 1000 N MIDKIFF RD
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City | MIDLAND
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State | TX
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Zip | 79701-2101
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Country | US
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Telephone | 432-897-0852
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 N MIDKIFF RD
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City | MIDLAND
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State | TX
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Zip | 79701
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Country | US
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Telephone | 407-353-5043
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN20468
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901021111
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 33366
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License Number State | TX
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