Divya Gulati, DDS
Individual provider Active NPI Dentist · Wauchula, FL
NPI 1326448804 · NPPES record last updated Jul 6, 2022
Key facts
- NPI
- 1326448804
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 31015 (TX)
- Practice address
- 322 S 6TH Ave
Wauchula, FL 33873-3207 - Phone
- (863) 773-9344
- NPI assigned
- Sep 3, 2014
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.030035 | IL | MD | Dentist |
| 31015 | TX | MD | Dentist |
| DN26793 | FL | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019.030035 | IL | |
| General Practice Dentistry | 1223G0001X | DN26793 | FL | |
| Dentist | 122300000X | 31015 | TX | Yes |
Addresses
Primary practice location
322 S 6TH Ave
Wauchula, FL 33873-3207
Mailing address
322 S 6TH Ave
Wauchula, FL 33873-3207
Phone (863) 773-9344
Other providers in Wauchula, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 6, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.