Provider Demographics
NPI:1518026228
Name:CHATTERJEE KIRK, PIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:PIA
Middle Name:
Last Name:CHATTERJEE KIRK
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 1:119 BEAUFORT CIRCLE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110
Mailing Address - Country:US
Mailing Address - Phone:601-984-6030
Mailing Address - Fax:601-984-6039
Practice Address - Street 1:2500 NORTH STATE STREET
Practice Address - Street 2:UNIVERSITY OF MISSISSIPPI SCHOOL OF DENTISTRY
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216
Practice Address - Country:US
Practice Address - Phone:601-984-6030
Practice Address - Fax:601-984-6039
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3175-011223G0001X
TX203441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00660414Medicaid