Healthcare Provider Details

I. General information

NPI: 1316734510
Provider Name (Legal Business Name): ANISHA KAKAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 MARTER AVE STE 204
MOORESTOWN NJ
08057-3124
US

IV. Provider business mailing address

99 BEAUVOIR AVE
SUMMIT NJ
07901-3533
US

V. Phone/Fax

Practice location:
  • Phone: 856-727-6453
  • Fax:
Mailing address:
  • Phone: 908-522-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI03151500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: