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General NPI Number Information
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NPI Number | 1821685041
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Entity Type | Organization
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Legal Business Name | ANISH GUPTA DDS PLLC
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Dates
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Enumeration Date | 12/22/2020
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Last Update Date | 03/06/2023
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Provider Practice Location Address
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Address Line | 30770 LYON CENTER DR. EAST
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City | NEW HUDSON
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State | MI
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Zip | 48165
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Country | US
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Telephone | 248-422-1555
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Fax | 248-422-0755
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Provider Business Mailing Address
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Address Line | 6736 PORTSMAN CT
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City | CANTON
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State | MI
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Zip | 48187-2176
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Country | US
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Telephone | 248-895-1451
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Fax |
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Authorized Official
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Title or Position | OWNER, ORAL AND MAXILLOFACIAL SURGE
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Name | DR. ANISH GUPTA
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Credential | DDS
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Telephone | 248-895-1451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number |
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License Number State |
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