Provider Demographics
NPI:1336679083
Name:CJ KARAS DDS OF COTTAGE GROVE
Entity Type:Organization
Organization Name:CJ KARAS DDS OF COTTAGE GROVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:KARAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:608-462-8282
Mailing Address - Street 1:5619 WINNEQUAH RD
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-3066
Mailing Address - Country:US
Mailing Address - Phone:608-212-9393
Mailing Address - Fax:
Practice Address - Street 1:2848 COTTAGE GROVE RD
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:WI
Practice Address - Zip Code:53527-8862
Practice Address - Country:US
Practice Address - Phone:608-212-9393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-15
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5583261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5583-15OtherWISCONSIN LICENSE NUMBER