Provider Demographics
NPI:1730301649
Name:GUPTA, RAJEEV (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAJEEV
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 LAKEHURST RD
Mailing Address - Street 2:PLAZA ONE
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755
Mailing Address - Country:US
Mailing Address - Phone:732-349-9222
Mailing Address - Fax:732-349-6213
Practice Address - Street 1:459 LAKEHURST RD
Practice Address - Street 2:PLAZA ONE
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755
Practice Address - Country:US
Practice Address - Phone:732-349-9222
Practice Address - Fax:732-349-6213
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI207731223E0200X
NJ2201020773001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics