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General NPI Number Information
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NPI Number | 1881904084
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Entity Type | Organization
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Legal Business Name | TINA GUPTA DDS PA II
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Dates
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Enumeration Date | 10/21/2010
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Last Update Date | 10/21/2010
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Provider Practice Location Address
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Address Line | 451 RUIN CREEK RD SUITE 201
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City | HENDERSON
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State | NC
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Zip | 27536-2878
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Country | US
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Telephone | 252-572-2520
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Fax | 252-572-2527
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Provider Business Mailing Address
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Address Line | 451 RUIN CREEK RD SUITE 201
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City | HENDERSON
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State | NC
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Zip | 27536-2878
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Country | US
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Telephone | 252-572-2520
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Fax | 252-572-2527
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Authorized Official
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Title or Position | DENTIST
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Name | DR. TINA GUPTA
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Credential | DDS
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Telephone | 252-572-2520
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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 |
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License Number State |
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