Provider Demographics
NPI:1043432271
Name:SAXENA, SUDIPTA (DDS)
Entity Type:Individual
Prefix:
First Name:SUDIPTA
Middle Name:
Last Name:SAXENA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BEVERLY RD
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-2630
Mailing Address - Country:US
Mailing Address - Phone:201-262-6387
Mailing Address - Fax:
Practice Address - Street 1:248 1ST ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-3411
Practice Address - Country:US
Practice Address - Phone:201-883-1886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1023053001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice