MEDICARE: SHALINI 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	1223G0001X	General Practice Dentistry	30023848	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30-023848	OTHER	OH	STATE DENTAL LICENSE

General Provider Information

NPI Number	:	1821342148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHALINI GUPTA DDS

Provider Business Mailing Address
First Line	:	8805 GOVERNORS HILL DR STE 105
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45249-3312
Country	:	US
Telephone Number	:	513-697-2640
Fax Number	:	513-697-2650

Provider Business Practice Location Address
First Line	:	12160 MONTGOMERY RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45249-1731
Country	:	US
Telephone Number	:	513-697-4300
Fax Number	:	513-697-2650

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

Provider Enumeration Date	:	11/08/2012
Last Update Date	:	11/08/2012

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