Individual provider Active NPI

Heena Gupta, DDS

  • General Practice Dentistry
  • South San Francisco, CA
National Provider Identifier
1770934846
Registry record updated Feb 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
103612 Issued in CA
Practice address
1241 Mission Rd
South San Francisco, CA 94080-1397
Phone
(650) 588-3710
NPI assigned
Jun 29, 2016
Last updated
Feb 2, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 2, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 32097 TX
General Practice Dentistry 1223G0001X 103612 CA Primary
Student in an Organized Health Care Education/Training Program 390200000X NU

Addresses

Primary practice location

1241 Mission Rd
South San Francisco, CA 94080-1397

Mailing address

1300 22ND St Apt 114
San Francisco, CA 94107-3832

Other practice location 1

3900 Woodland Ave
Philadelphia, PA 19104-4551
Phone (215) 823-5800 ext. 5822

Other practice location 2

4203 Medical Pkwy
Austin, TX 78756-3309
Phone (512) 371-7239

Other practice location 3

100 S Ellsworth Ave Ste 601
San Mateo, CA 94401
Phone (650) 342-9941

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
103612CAMDGeneral Practice Dentistry
32097TXMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Jmmdds PLLC General Practice Past Accepting new patients
Sylvie M Galerneau, DMD PastSince Sep 1, 2019 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1467158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580601600000",
    "number": "1770934846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 22ND ST APT 114",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941073832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1241 MISSION RD",
            "city": "SOUTH SAN FRANCISCO",
            "state": "CA",
            "postal_code": "940801397",
            "telephone_number": "650-588-3710"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3900 Woodland Ave",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191044551",
            "country_code": "US",
            "telephone_number": "215-823-5800 x5822",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4203 Medical Pkwy",
            "address_purpose": "LOCATION",
            "city": "Austin",
            "state": "TX",
            "postal_code": "787563309",
            "country_code": "US",
            "telephone_number": "512-371-7239",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 S Ellsworth Ave Ste 601",
            "address_purpose": "LOCATION",
            "city": "San Mateo",
            "state": "CA",
            "postal_code": "94401",
            "country_code": "US",
            "telephone_number": "650-342-9941",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUPTA",
        "first_name": "HEENA",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-06-29",
        "last_updated": "2020-02-02",
        "certification_date": "2020-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "32097",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "103612",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South San Francisco, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2020; 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.