IndividualActive
Shivane Gupta, MD
NPI 1295046399 · Oral & Maxillofacial Surgery (D.M.D.) · Lilburn, GA
Provider details
- NPI number
- 1295046399
- Entity type
- Individual
- Primary specialty
- Oral & Maxillofacial Surgery (D.M.D.)Allopathic & Osteopathic Physicians
- Credential
- MD
- Sex
- Male
- Sole proprietor
- Yes
- License
- 078309 (GA)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
4150 Five Forks Trickum Rd Sw Ste 1
Lilburn, GA 30047-3130
Phone: (770) 717-7225
Fax: (770) 717-7228
Approximate (ZIP-level) locationGet directions
Mailing address
4150 Five Forks Trickum Rd Sw Ste 1
Lilburn, GA 30047-3130
Registry dates
- Enumerated
- 2010-06-24
- Last updated
- 2022-07-06
- Certified
- 2022-07-06
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.