Provider Demographics
NPI:1366583676
Name:GUPTA, LOVEENA (DDS)
Entity type:Individual
Prefix:DR
First Name:LOVEENA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 N TRIPHAMMER RD
Mailing Address - Street 2:SUITE 63
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1576
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2255 N TRIPHAMMER RD
Practice Address - Street 2:SUITE 63
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1576
Practice Address - Country:US
Practice Address - Phone:607-257-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0504011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02364372Medicaid