Provider Demographics
NPI:1285306779
Name:NIDHI GUPTA, DDS, A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:NIDHI GUPTA, DDS, A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NIDHI
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-375-6814
Mailing Address - Street 1:11644 CIRCLE WAY
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-2761
Mailing Address - Country:US
Mailing Address - Phone:498-375-6814
Mailing Address - Fax:
Practice Address - Street 1:1650 B ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-3020
Practice Address - Country:US
Practice Address - Phone:408-375-6814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-02
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty