# DENTAL OF LODI PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003364332
- **Authorized official:** VIKAS GUPTA (DENTIST)
- **Authorized official phone:** (973) 302-2066

## Contact information

- **Practice address:** 1 S MAIN ST STE 6, LODI, NJ 07644-2235
- **Practice address phone:** (973) 302-2066
- **Mailing address:** 1 S MAIN ST STE 6, LODI, NJ 07644-2235
- **Mailing address phone:** (973) 302-2066

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 22DI02602300 | NJ | Yes |

## Other

- **Enumeration date:** 09/15/2016
- **Last updated:** 09/15/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1215357637 | NPI | NJ |
| 01 | — | 1750788402 | NPI | NJ |