Healthcare Provider Details

I. General information

NPI: 1518168343
Provider Name (Legal Business Name): PRIYU GUPTA D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 OLD HOOK RD STE 201
WESTWOOD NJ
07675-3248
US

IV. Provider business mailing address

289 ORANGEBURGH RD
OLD TAPPAN NJ
07675-7484
US

V. Phone/Fax

Practice location:
  • Phone: 917-520-4176
  • Fax: 201-664-0912
Mailing address:
  • Phone: 917-520-4176
  • Fax: 201-664-0912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number22DI02253800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: