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General NPI Number Information
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NPI Number | 1164927059
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Entity Type | Individual
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Provider Name | SAURABH GUPTA DDS
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Gender | Male
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Dates
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Enumeration Date | 03/24/2018
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Last Update Date | 08/30/2023
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Provider Practice Location Address
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Address Line | 200 WESTGATE CIR STE 104
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City | ANNAPOLIS
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State | MD
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Zip | 21401-3378
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Country | US
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Telephone | 410-268-4770
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Fax |
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Provider Business Mailing Address
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Address Line | 9797 NORTHERN LAKES LN
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City | LAUREL
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State | MD
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Zip | 20723-5893
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Country | US
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Telephone |
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DS042830
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 18119
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License Number State | MD
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