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General NPI Number Information
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NPI Number | 1134465040
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Entity Type | Organization
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Legal Business Name | GEORGE KOUTSOUKOS DDS, INC
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Dates
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Enumeration Date | 12/20/2012
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Last Update Date | 12/20/2012
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Provider Practice Location Address
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Address Line | 24155 MAGIC MOUNTAIN PKWY
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City | VALENCIA
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State | CA
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Zip | 91355-3904
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Country | US
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Telephone | 661-222-7724
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Fax | 661-222-7464
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Provider Business Mailing Address
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Address Line | 24155 MAGIC MOUNTAIN PKWY
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City | VALENCIA
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State | CA
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Zip | 91355-3904
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Country | US
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Telephone | 661-222-7724
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Fax | 661-222-7464
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Authorized Official
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Title or Position | OWNER
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Name | DR. GEORGE KON KOUTSOUKOS
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Credential | D.D.S
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Telephone | 661-222-7724
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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