Provider Demographics
NPI:1841361409
Name:MUKHERJEE, UDITT (DMD)
Entity type:Individual
Prefix:DR
First Name:UDITT
Middle Name:
Last Name:MUKHERJEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12720 S ROUTE 59 UNIT 102
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-5528
Mailing Address - Country:US
Mailing Address - Phone:815-254-5840
Mailing Address - Fax:216-593-7533
Practice Address - Street 1:12720 S ROUTE 59 UNIT 102
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-5528
Practice Address - Country:US
Practice Address - Phone:815-254-5480
Practice Address - Fax:216-584-1089
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0242301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice