Provider Demographics
NPI:1629539432
Name:CHAKRABORTY, AMRITA
Entity type:Individual
Prefix:DR
First Name:AMRITA
Middle Name:
Last Name:CHAKRABORTY
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 1:1519 NE F ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-4234
Mailing Address - Country:US
Mailing Address - Phone:541-612-3537
Mailing Address - Fax:
Practice Address - Street 1:1519 NE F ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-4234
Practice Address - Country:US
Practice Address - Phone:541-612-3537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD11627122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist