MEDICARE: DEEPAK GUPTA D.M.D.

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	1223G0001X	General Practice Dentistry	DN013967	GA

General Provider Information

NPI Number	:	1821229808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEEPAK GUPTA D.M.D.

Provider Business Mailing Address
First Line	:	207 E 31ST ST
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31401-7304
Country	:	US
Telephone Number	:	912-232-2779
Fax Number	:	912-236-1962

Provider Business Practice Location Address
First Line	:	207 E 31ST ST
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31401-7304
Country	:	US
Telephone Number	:	912-232-2779
Fax Number	:	912-236-1962

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

Provider Enumeration Date	:	08/07/2009
Last Update Date	:	08/07/2009

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