Healthcare Provider Details

I. General information

NPI: 1275909467
Provider Name (Legal Business Name): GEORGIOS KOTSAKIS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST BOX, 357444
SEATTLE WA
98195-7444
US

IV. Provider business mailing address

1959 NE PACIFIC ST BOX, 357444
SEATTLE WA
98195-7444
US

V. Phone/Fax

Practice location:
  • Phone: 206-616-9412
  • Fax:
Mailing address:
  • Phone: 206-616-9412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDF60582867
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: