Provider Demographics
NPI:1396230884
Name:CHAKOTE, KARUNESH
Entity Type:Individual
Prefix:
First Name:KARUNESH
Middle Name:
Last Name:CHAKOTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 COSMOPOLITAN DR NE UNIT 711
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-3626
Mailing Address - Country:US
Mailing Address - Phone:516-474-7958
Mailing Address - Fax:
Practice Address - Street 1:201 NEWNAN CROSSING BYP
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1063
Practice Address - Country:US
Practice Address - Phone:678-621-6410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1222981223X0400X, 1223G0001X
OH300255091223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice