Provider Demographics
NPI:1013376904
Name:GUPTA, ANUKRITI (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANUKRITI
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 FEDERAL ST STE 300
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1539
Mailing Address - Country:US
Mailing Address - Phone:856-583-2400
Mailing Address - Fax:856-541-4611
Practice Address - Street 1:817 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1539
Practice Address - Country:US
Practice Address - Phone:856-583-2400
Practice Address - Fax:856-541-4611
Is Sole Proprietor?:No
Enumeration Date:2016-02-19
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
RIDEN033481223G0001X
NJ22DI026742001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0604381Medicaid