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General NPI Number Information
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NPI Number | 1215691316
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Entity Type | Individual
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Provider Name | PRAFULL DAS GUPTA DMD
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Gender | Male
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Dates
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Enumeration Date | 10/25/2021
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Last Update Date | 10/25/2021
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Provider Practice Location Address
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Address Line | 239 S BURLINGTON BLVD
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City | BURLINGTON
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State | WA
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Zip | 98233-1708
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Country | US
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Telephone | 360-707-5353
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Fax |
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Provider Business Mailing Address
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Address Line | 1101-1473 JOHNSTON RD
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City | WHITE ROCK
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State | BRITISH COLUMBIA
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Zip | V4B 0A2
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Country | CA
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DE61212830
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License Number State | WA
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