MEDICARE: DR. AMRITA CHAKRABORTY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D11627	OR

General Provider Information

NPI Number	:	1629539432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMRITA CHAKRABORTY

Provider Business Mailing Address
First Line	:	1519 NE F ST
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-4234
Country	:	US
Telephone Number	:	541-612-3537
Fax Number	:

Provider Business Practice Location Address
First Line	:	1519 NE F ST
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-4234
Country	:	US
Telephone Number	:	541-612-3537
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2019
Last Update Date	:	09/29/2022

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