Organization
DENTAL OF LODI PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VIKAS GUPTA (DENTIST)
(973) 302-2066
Entity
Organization
Contact information
Practice address
1 S MAIN ST STE 6, LODI, NJ 07644-2235
(973) 302-2066
Mailing address
1 S MAIN ST STE 6, LODI, NJ 07644-2235
(973) 302-2066
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
22DI02602300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1215357637
NPI
NJ
01
—
1750788402
NPI
NJ
Enumeration date
09/15/2016
Last updated
09/15/2016
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