Provider Demographics
NPI:1720252380
Name:TOMMY KAKOURAS DMD PA
Entity type:Organization
Organization Name:TOMMY KAKOURAS DMD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ATHANASIOS
Authorized Official - Middle Name:PANAGIOTIS
Authorized Official - Last Name:KAKOURAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:704-504-8070
Mailing Address - Street 1:11020 SOUTH TRYON STREET
Mailing Address - Street 2:SUITE 401
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-6661
Mailing Address - Country:US
Mailing Address - Phone:704-504-8070
Mailing Address - Fax:704-504-8885
Practice Address - Street 1:11020 SOUTH TRYON STREET
Practice Address - Street 2:SUITE 401
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-6661
Practice Address - Country:US
Practice Address - Phone:704-504-8070
Practice Address - Fax:704-504-8885
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOMMY KAKOURAS DMD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7838122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty