Individual provider Active NPI

Manish Gupta, D.D.S

  • Dentist
  • Cleveland, OH
National Provider Identifier
1891007936
Registry record updated Jul 6, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
30023291 Issued in OH
Practice address
11201 Shaker Blvd Ste 136
Cleveland, OH 44104-3833
Phone
(216) 368-7238
Fax
(217) 791-8322
NPI assigned
Jul 6, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 30023291 OH Primary

Addresses

Primary practice location

11201 Shaker Blvd Ste 136
Cleveland, OH 44104-3833

Mailing address

11201 Shaker Blvd Ste 136
Cleveland, OH 44104-3833
Phone (216) 368-7238

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160901002249 OH Order and Referring Only - DentistPractitioner - Dentist 6901192863

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
30023291OHMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1278374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278374400000",
    "number": "1891007936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11201 SHAKER BLVD STE 136",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441043833",
            "telephone_number": "216-368-7238",
            "fax_number": "217-791-8322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11201 SHAKER BLVD STE 136",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441043833",
            "telephone_number": "216-368-7238",
            "fax_number": "217-791-8322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUPTA",
        "first_name": "MANISH",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-06",
        "last_updated": "2010-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30023291",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

Verify at the official NPI Registry.