Provider Demographics
NPI:1790338952
Name:TROY MEADOWS DENTAL PC
Entity Type:Organization
Organization Name:TROY MEADOWS DENTAL PC
Other - Org Name:TROY MEADOWS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADITYA
Authorized Official - Middle Name:PRASHAD
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-860-9724
Mailing Address - Street 1:488 N BEVERWYCK RD STE B
Mailing Address - Street 2:
Mailing Address - City:LAKE HIAWATHA
Mailing Address - State:NJ
Mailing Address - Zip Code:07034-2511
Mailing Address - Country:US
Mailing Address - Phone:973-860-9724
Mailing Address - Fax:973-860-9773
Practice Address - Street 1:488 N BEVERWYCK RD STE B
Practice Address - Street 2:
Practice Address - City:LAKE HIAWATHA
Practice Address - State:NJ
Practice Address - Zip Code:07034-2511
Practice Address - Country:US
Practice Address - Phone:973-860-9724
Practice Address - Fax:973-860-9774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-17
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty