Provider Demographics
NPI:1285887497
Name:ROBERT J. KAKOS DDS PC
Entity type:Organization
Organization Name:ROBERT J. KAKOS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:KAKOS
Authorized Official - Suffix:
Authorized Official - Credentials:D D S
Authorized Official - Phone:770-992-4844
Mailing Address - Street 1:1150 GRIMES BRIDGE RD
Mailing Address - Street 2:STE. 200
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-3988
Mailing Address - Country:US
Mailing Address - Phone:770-992-4844
Mailing Address - Fax:770-641-1511
Practice Address - Street 1:1150 GRIMES BRIDGE RD
Practice Address - Street 2:STE. 200
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-3988
Practice Address - Country:US
Practice Address - Phone:770-992-4844
Practice Address - Fax:770-641-1511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN008427261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA70063219DAMedicare PIN
GAT86993Medicare UPIN