Provider Demographics
NPI:1821685041
Name:ANISH GUPTA DDS PLLC
Entity Type:Organization
Organization Name:ANISH GUPTA DDS PLLC
Other - Org Name:LYON DENTAL IMPLANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, ORAL AND MAXILLOFACIAL SURGE
Authorized Official - Prefix:DR
Authorized Official - First Name:ANISH
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-895-1451
Mailing Address - Street 1:6736 PORTSMAN CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2176
Mailing Address - Country:US
Mailing Address - Phone:248-895-1451
Mailing Address - Fax:
Practice Address - Street 1:30770 LYON CENTER DR. EAST
Practice Address - Street 2:
Practice Address - City:NEW HUDSON
Practice Address - State:MI
Practice Address - Zip Code:48165
Practice Address - Country:US
Practice Address - Phone:248-422-1555
Practice Address - Fax:248-422-0755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-22
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty