Individual
BHASKAR GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
110 S 2ND ST, ELLINGTON, MO 63638-9400
(573) 663-2313
Mailing address
85 WAYNE 216, LODI, MO 63950-8726
(661) 741-7929
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
107390
CA
1223G0001X
General Practice Dentistry
Primary
2023044154
MO
Other
Enumeration date
10/18/2022
Last updated
11/12/2024
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