Provider Demographics
NPI:1336758382
Name:MENGJI, CHITTI (DDS)
Entity Type:Individual
Prefix:
First Name:CHITTI
Middle Name:
Last Name:MENGJI
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 1:3441 KILBURN CIR APT 618
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1137
Mailing Address - Country:US
Mailing Address - Phone:973-727-2373
Mailing Address - Fax:
Practice Address - Street 1:3441 KILBURN CIR APT 618
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-1137
Practice Address - Country:US
Practice Address - Phone:973-727-2373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014170851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice