Healthcare Provider Details

I. General information

NPI: 1811563778
Provider Name (Legal Business Name): MYKOLAS VARKALIS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 BRASELTON HWY STE 101
DACULA GA
30019-4696
US

IV. Provider business mailing address

901 N COLORADO BLVD APT 5217
DENVER CO
80206-4091
US

V. Phone/Fax

Practice location:
  • Phone: 770-614-9467
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2901601926
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN122335
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN.00204863
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: