Healthcare Provider Details

I. General information

NPI: 1538901467
Provider Name (Legal Business Name): ARCHAK CHAKRABORTY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4203 SE FEDERAL HWY
STUART FL
34997-4925
US

IV. Provider business mailing address

4203 SE FEDERAL HWY
STUART FL
34997-4925
US

V. Phone/Fax

Practice location:
  • Phone: 628-358-8660
  • Fax:
Mailing address:
  • Phone: 628-358-8660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN32408
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: