Provider Demographics
NPI:1215691316
Name:GUPTA, PRAFULL DAS (DMD)
Entity type:Individual
Prefix:
First Name:PRAFULL DAS
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101-1473 JOHNSTON RD
Mailing Address - Street 2:
Mailing Address - City:WHITE ROCK
Mailing Address - State:BRITISH COLUMBIA
Mailing Address - Zip Code:V4B 0A2
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:239 S BURLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-1708
Practice Address - Country:US
Practice Address - Phone:360-707-5353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61212830122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist