Provider Demographics
NPI:1477254100
Name:JONCHHE KARMACHARYA, SUJATA
Entity Type:Individual
Prefix:
First Name:SUJATA
Middle Name:
Last Name:JONCHHE KARMACHARYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 PRESTON ST APT 5D
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-2562
Mailing Address - Country:US
Mailing Address - Phone:617-369-2242
Mailing Address - Fax:
Practice Address - Street 1:79 LYNNFIELD ST
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-5201
Practice Address - Country:US
Practice Address - Phone:978-587-3368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18599841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice