NPI 1295046399

Shivane K Gupta, MD

Practitioner Oral & Maxillofacial Surgery (D.M.D.) Lilburn, GA

Practice location

Address: 4150 Five Forks Trickum Rd SW STE 1, Lilburn, GA 30047-3130
Phone: (770) 717-7225
Fax: (770) 717-7228

Registered specialties

Oral & Maxillofacial Surgery (D.M.D.) Primary

Allopathic & Osteopathic Physicians Taxonomy 204E00000X Licence 078309 (GA)

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Registry record

NPI: 1295046399
Entity type: Individual
Sex (as registered): Male
NPI issued: 24 Jun 2010
Record last updated: 6 Jul 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.