Preeti Gupta, DDS
Individual provider Active NPI Dentist · Coon Rapids, MN
NPI 1457701377 · NPPES record last updated Jun 21, 2016
Key facts
- NPI
- 1457701377
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- D13716 (MN)
- Practice address
- 8960 Springbrook Dr NW Ste 150
Coon Rapids, MN 55433-5809 - Phone
- (763) 784-7570
- NPI assigned
- Jun 21, 2016
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160721000062 | MN | Order and Referring Only - Oral Surgery |
3173816675 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D13716 | MN | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D13716 | MN | Yes |
Addresses
Primary practice location
8960 Springbrook Dr NW Ste 150
Coon Rapids, MN 55433-5809
Mailing address
8960 Springbrook Dr NW Ste 150
Coon Rapids, MN 55433-5809
Phone (763) 784-7570
Other providers in Coon Rapids, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 21, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.