Provider Demographics
NPI:1437607942
Name:KONSTANTINOS HAROGIANNIS; PLLC
Entity Type:Organization
Organization Name:KONSTANTINOS HAROGIANNIS; PLLC
Other - Org Name:WASHINGTON PARK DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGLOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-778-7707
Mailing Address - Street 1:271 S DOWNING ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-2432
Mailing Address - Country:US
Mailing Address - Phone:303-778-7707
Mailing Address - Fax:
Practice Address - Street 1:271 S DOWNING ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-2432
Practice Address - Country:US
Practice Address - Phone:303-778-7707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-13
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO10625038Medicaid