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General NPI Number Information
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NPI Number | 1558942524
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Entity Type | Individual
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Provider Name | DIVYA THAKUR DDS
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Gender | Female
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Dates
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Enumeration Date | 04/20/2021
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Last Update Date | 04/25/2021
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Provider Practice Location Address
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Address Line | 385 TREMONT AVE
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City | EAST ORANGE
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State | NJ
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Zip | 07018-1023
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Country | US
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Telephone | 973-676-1000
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Fax | 973-395-7019
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Provider Business Mailing Address
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Address Line | 24 REMER AVE
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City | SPRINGFIELD
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State | NJ
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Zip | 07081-3226
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Country | US
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Telephone | 908-574-8277
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Fax |
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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 | 22DI02820300
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License Number State | NJ
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