MEDICARE: UPPAL DENTAL CORP

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	DDS55640	CA

General Provider Information

NPI Number	:	1336451368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPPAL DENTAL CORP

Provider Business Mailing Address
First Line	:	1014 N VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-2620
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1014 N VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-2620
Country	:	US
Telephone Number	:	732-254-1994
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GAGAN UPPAL
Credential	:	DMD
Telephone Number	:	732-254-1994

Provider Enumeration Date	:	07/07/2010
Last Update Date	:	07/07/2010

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Directions to “UPPAL DENTAL CORP ” Practice Location

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