=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508666918
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BHAWNA GUPTA DENTAL PRACTICE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2025
-----------------------------------------------------
Last Update Date | 03/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1937 TULLY RD STE B
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95122-1934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-929-9398
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 350 N BAYVIEW AVE
-----------------------------------------------------
City | SUNNYVALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94085-4324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-603-0281
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. BHAWNA GUPTA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 858-603-0281
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------