Provider Demographics
NPI:1407068869
Name:MUKHERJEE, KRISTIE (DDS)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:
Last Name:MUKHERJEE
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 1:170 UNDERCLIFF AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1125
Mailing Address - Country:US
Mailing Address - Phone:201-917-5717
Mailing Address - Fax:
Practice Address - Street 1:164 MADISON AVE FL 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5411
Practice Address - Country:US
Practice Address - Phone:212-685-2890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-05
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051146-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist