Healthcare Provider Details

I. General information

NPI: 1841923877
Provider Name (Legal Business Name): WESTWOOD PERIODONTICS,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
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

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

V. Phone/Fax

Practice location:
  • Phone: 201-664-3023
  • Fax: 201-664-0912
Mailing address:
  • Phone: 201-664-3023
  • Fax: 201-664-0912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. PRIYU GUPTA
Title or Position: OWNER
Credential: DDS
Phone: 201-664-3023