Provider Demographics
NPI:1255633780
Name:DASGUPTA, SHOMALI (DDS)
Entity type:Individual
Prefix:DR
First Name:SHOMALI
Middle Name:
Last Name:DASGUPTA
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 1:143 WOODBURY RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2973
Mailing Address - Country:US
Mailing Address - Phone:732-906-3521
Mailing Address - Fax:
Practice Address - Street 1:143 WOODBURY RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2973
Practice Address - Country:US
Practice Address - Phone:914-275-3439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-05
Last Update Date:2010-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DJ02451500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist