Provider Demographics
NPI:1134465040
Name:GEORGE KOUTSOUKOS DDS, INC
Entity Type:Organization
Organization Name:GEORGE KOUTSOUKOS DDS, INC
Other - Org Name:ELITE SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:KON
Authorized Official - Last Name:KOUTSOUKOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-222-7724
Mailing Address - Street 1:24155 MAGIC MOUNTAIN PKWY
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-3904
Mailing Address - Country:US
Mailing Address - Phone:661-222-7724
Mailing Address - Fax:661-222-7464
Practice Address - Street 1:24155 MAGIC MOUNTAIN PKWY
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-3904
Practice Address - Country:US
Practice Address - Phone:661-222-7724
Practice Address - Fax:661-222-7464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty