Vandana Gupta, D.D.S

Primary specialty

DentistTaxonomy code 122300000X

License

019-023475 Issued in IL

Practice address

6000 Bond Ave
Centreville, IL 62207-2328

Phone

(618) 332-2740

Fax

(618) 332-8755

NPI assigned

Oct 25, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323907200000",
    "number": "1689664286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6000 BOND AVE",
            "city": "CENTREVILLE",
            "state": "IL",
            "postal_code": "622072328",
            "telephone_number": "618-332-2740",
            "fax_number": "618-332-8755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6000 BOND AVE",
            "city": "CENTREVILLE",
            "state": "IL",
            "postal_code": "622072328",
            "telephone_number": "618-332-2740",
            "fax_number": "618-332-8755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUPTA",
        "first_name": "VANDANA",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-25",
        "last_updated": "2011-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019-023475",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emma C Clardy, DO
• Terrilyne Cole, MD, MBA
• Porshia Lenee' Egerson, LMT
• Kalyani Gavini, M.D.
• Michelle Gaydenhopkins
• Ameanna Vusu Hamilton
• Roberta Johnson
• Laura Anne Lengyel, MA, LCPC, ATR-BC
• Justine Ann Livesay, LCPC
• Heather L Lucas-Foster, M.D.

• Dentist in Centreville, IL
• Providers in Centreville, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.