Provider Demographics
NPI:1316711922
Name:DMITRY KARAGODSKY PC
Entity type:Organization
Organization Name:DMITRY KARAGODSKY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL, DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:DMITRY
Authorized Official - Middle Name:
Authorized Official - Last Name:KARAGODSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-969-2015
Mailing Address - Street 1:1775 STREET RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-4564
Mailing Address - Country:US
Mailing Address - Phone:215-969-2001
Mailing Address - Fax:
Practice Address - Street 1:1775 STREET RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-4564
Practice Address - Country:US
Practice Address - Phone:215-969-2001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty