Provider Demographics
NPI:1548628993
Name:GUPTA, ADITYA PRASHAD (DDS)
Entity type:Individual
Prefix:DR
First Name:ADITYA
Middle Name:PRASHAD
Last Name:GUPTA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:488 N BEVERWYCK RD STE B
Mailing Address - Street 2:
Mailing Address - City:LAKE HIAWATHA
Mailing Address - State:NJ
Mailing Address - Zip Code:07034-2511
Mailing Address - Country:US
Mailing Address - Phone:973-860-9724
Mailing Address - Fax:973-860-9774
Practice Address - Street 1:488 N BEVERWYCK RD STE B
Practice Address - Street 2:
Practice Address - City:LAKE HIAWATHA
Practice Address - State:NJ
Practice Address - Zip Code:07034-2511
Practice Address - Country:US
Practice Address - Phone:973-860-9724
Practice Address - Fax:973-860-9774
Is Sole Proprietor?:No
Enumeration Date:2016-01-31
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0592581223G0001X
PADS0416001223G0001X
IL0190320071223G0001X
NJ22DI026485001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice