Provider Demographics
NPI:1982624375
Name:KAKOS, ROBERT JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JAMES
Last Name:KAKOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 GRIMES BRIDGE RD
Mailing Address - Street 2:SUITE 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:SUITE 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0084271223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
581377835OtherTAX IDENTIFICATION NUMBE
581377835OtherTAX IDENTIFICATION NUMBE
T86993Medicare UPIN