Healthcare Provider Details

I. General information

NPI: 1396230884
Provider Name (Legal Business Name): KARUNESH CHAKOTE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 NEWNAN CROSSING BYP
NEWNAN GA
30265-1063
US

IV. Provider business mailing address

711 COSMOPOLITAN DR NE UNIT 711
ATLANTA GA
30324-3626
US

V. Phone/Fax

Practice location:
  • Phone: 678-621-6410
  • Fax:
Mailing address:
  • Phone: 516-474-7958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN122298
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number30025509
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN122298
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: