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General NPI Number Information
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NPI Number | 1275122764
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Entity Type | Individual
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Provider Name | SHREYA GUPTA
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Gender | Female
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Dates
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Enumeration Date | 01/11/2021
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Last Update Date | 01/11/2021
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Provider Practice Location Address
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Address Line | 4539 E SAM HOUSTON PKWY S
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City | PASADENA
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State | TX
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Zip | 77505-3953
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Country | US
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Telephone | 408-799-0778
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Fax |
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Provider Business Mailing Address
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Address Line | 9500 SW DIAMOND VIEW WAY
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City | BEAVERTON
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State | OR
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Zip | 97007-9420
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Country | US
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Telephone | 408-799-0778
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D11354
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License Number State | OR
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