Provider Demographics
NPI:1215041629
Name:KOURAKIN, GEORGE GEORGI (DMD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:GEORGI
Last Name:KOURAKIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-1649
Mailing Address - Country:US
Mailing Address - Phone:609-625-4651
Mailing Address - Fax:609-625-1298
Practice Address - Street 1:16 W VINE ST
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-3823
Practice Address - Country:US
Practice Address - Phone:856-825-0618
Practice Address - Fax:856-825-3420
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD130651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice