Provider Demographics
NPI:1326249061
Name:KOUTRAS, JOHN DEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DEAN
Last Name:KOUTRAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 OLENTANGY RIVER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-3119
Mailing Address - Country:US
Mailing Address - Phone:614-294-4007
Mailing Address - Fax:614-294-7008
Practice Address - Street 1:1275 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-3119
Practice Address - Country:US
Practice Address - Phone:614-294-4007
Practice Address - Fax:614-294-7008
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH190801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice