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General NPI Number Information
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NPI Number | 1760530943
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Entity Type | Organization
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Legal Business Name | GEORGE KOURAKIN DMD, PA
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Dates
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Enumeration Date | 01/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 16 W VINE ST
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City | MILLVILLE
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State | NJ
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Zip | 08332-3823
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Country | US
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Telephone | 856-825-0618
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Fax | 856-825-3420
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Provider Business Mailing Address
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Address Line | 16 W VINE ST
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City | MILLVILLE
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State | NJ
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Zip | 08332-3823
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Country | US
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Telephone | 856-825-0618
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Fax | 856-825-3420
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Authorized Official
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Title or Position | OWNER
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Name | DR. GEORGE GEORGI KOURAKIN
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Credential | D.M.D.
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Telephone | 856-825-0618
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D13065
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License Number State | NJ
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