Provider Demographics
NPI:1366620593
Name:GUPTA, SHIKA
Entity type:Individual
Prefix:DR
First Name:SHIKA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 RALSTON AVE
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-1615
Mailing Address - Country:US
Mailing Address - Phone:650-591-4704
Mailing Address - Fax:650-591-4531
Practice Address - Street 1:2130 RALSTON AVE
Practice Address - Street 2:SUITE 1D
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-1615
Practice Address - Country:US
Practice Address - Phone:650-591-4704
Practice Address - Fax:650-591-4531
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56143122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist