Provider Demographics
NPI:1609922509
Name:GUPTA, ANU (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANU
Middle Name:
Last Name:GUPTA
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 1:39 W 32ND ST
Mailing Address - Street 2:SUITE 503
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3803
Mailing Address - Country:US
Mailing Address - Phone:917-301-2498
Mailing Address - Fax:212-564-5027
Practice Address - Street 1:39 W 32ND ST
Practice Address - Street 2:SUITE 503
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3803
Practice Address - Country:US
Practice Address - Phone:917-301-2498
Practice Address - Fax:212-564-5027
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0424641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice