Provider Demographics
NPI:1992193882
Name:JESSICA J KAKOS DDS, PC
Entity type:Organization
Organization Name:JESSICA J KAKOS DDS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:JAMEEL
Authorized Official - Last Name:KAKOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-489-5950
Mailing Address - Street 1:32905 W 12 MILE RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3342
Mailing Address - Country:US
Mailing Address - Phone:248-489-5950
Mailing Address - Fax:248-489-9667
Practice Address - Street 1:32905 W 12 MILE RD
Practice Address - Street 2:SUITE 240
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3342
Practice Address - Country:US
Practice Address - Phone:248-489-5950
Practice Address - Fax:248-489-9667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018996122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty