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General NPI Number Information
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NPI Number | 1609214204
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Entity Type | Organization
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Legal Business Name | GAGAN UPPAL DDS CORPORATION
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Dates
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Enumeration Date | 06/05/2013
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Last Update Date | 06/05/2013
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Provider Practice Location Address
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Address Line | 5405 ALTON PKWY STE F
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City | IRVINE
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State | CA
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Zip | 92604-3719
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Country | US
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Telephone | 949-262-0300
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Fax | 949-262-0303
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Provider Business Mailing Address
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Address Line | 5405 ALTON PKWY STE F
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City | IRVINE
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State | CA
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Zip | 92604-3719
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Country | US
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Telephone | 949-262-0300
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Fax | 949-262-0303
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Authorized Official
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Title or Position | DMD
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Name | GAGAN UPPAL
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Credential |
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Telephone | 949-262-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 55640
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License Number State | CA
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