Provider Demographics
NPI:1710325378
Name:CHANGKAKOTY, BINITA (DDS)
Entity Type:Individual
Prefix:
First Name:BINITA
Middle Name:
Last Name:CHANGKAKOTY
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 1:160 D-1 CONCORD COMMONS PLACE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027
Mailing Address - Country:US
Mailing Address - Phone:908-906-5705
Mailing Address - Fax:252-744-2827
Practice Address - Street 1:160 D-1 CONCORD COMMONS PLACE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027
Practice Address - Country:US
Practice Address - Phone:908-906-5705
Practice Address - Fax:252-744-2827
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC97051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice