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General NPI Number Information
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NPI Number | 1548628993
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Entity Type | Individual
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Provider Name | ADITYA PRASHAD GUPTA D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 01/31/2016
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Last Update Date | 04/02/2020
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Provider Practice Location Address
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Address Line | 488 N BEVERWYCK RD STE B
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City | LAKE HIAWATHA
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State | NJ
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Zip | 07034-2511
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Country | US
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Telephone | 973-860-9724
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Fax | 973-860-9774
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Provider Business Mailing Address
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Address Line | 488 N BEVERWYCK RD STE B
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City | LAKE HIAWATHA
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State | NJ
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Zip | 07034-2511
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Country | US
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Telephone | 973-860-9724
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Fax | 973-860-9774
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 059258
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS041600
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019032007
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22DI02648500
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License Number State | NJ
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