MEDICARE: VICK GUPTA DDS MSD PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1174376164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICK GUPTA DDS MSD PLLC

Provider Business Mailing Address
First Line	:	1419 HAINES AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-2419
Country	:	US
Telephone Number	:	517-614-4664
Fax Number	:

Provider Business Practice Location Address
First Line	:	1222 N BISHOP AVE STE 500
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-4178
Country	:	US
Telephone Number	:	517-614-4664
Fax Number	:

Authorized Official
Title or Position	:	ORTHODONTIST/OWNER
Name	:	DR. VIKAS GUPTA
Credential	:	DDS, MSD
Telephone Number	:	517-614-4664

Provider Enumeration Date	:	04/09/2024
Last Update Date	:	04/09/2024

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