MEDICARE: DR. RAJJU GUPTA DDS

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	122300000X	Dentist	7084	OK

General Provider Information

NPI Number	:	1417443474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAJJU GUPTA DDS

Provider Business Mailing Address
First Line	:	5908 REGIS CT
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73034-8010
Country	:	US
Telephone Number	:	346-413-9976
Fax Number	:

Provider Business Practice Location Address
First Line	:	1040 NE 36TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73111-5002
Country	:	US
Telephone Number	:	405-967-7742
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2018
Last Update Date	:	02/12/2026

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