Individual
MR. RAJAN GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9918 ILLINOIS RD, FORT WAYNE, IN 46804-5770
(260) 888-3502
(260) 233-6656
Mailing address
9918 ILLINOIS RD, FORT WAYNE, IN 46804-5770
(260) 888-3502
(260) 233-6656
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DD4363
NM
1223E0200X
Endodontics
Primary
12013764A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12013764A
DENTAL BOARD
IN
Enumeration date
07/07/2015
Last updated
04/06/2024
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