Healthcare Provider Details

I. General information

NPI: 1235706920
Provider Name (Legal Business Name): NILIKA GULATI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 BRIDGE AVE # 66
RED BANK NJ
07701-6433
US

IV. Provider business mailing address

64 W GEORGE PL
ISELIN NJ
08830-1145
US

V. Phone/Fax

Practice location:
  • Phone: 732-219-6620
  • Fax:
Mailing address:
  • Phone: 908-487-1213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI02881000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: