Provider Demographics
NPI:1477766327
Name:KAKARIS FAMILY DENTISTRY PC
Entity Type:Organization
Organization Name:KAKARIS FAMILY DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ARESTEA
Authorized Official - Middle Name:ATHANASIOS
Authorized Official - Last Name:KAKARIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-676-1656
Mailing Address - Street 1:21080 ALLEN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-1602
Mailing Address - Country:US
Mailing Address - Phone:734-676-1656
Mailing Address - Fax:734-362-8662
Practice Address - Street 1:21080 ALLEN RD
Practice Address - Street 2:SUITE A
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-1602
Practice Address - Country:US
Practice Address - Phone:734-676-1656
Practice Address - Fax:734-362-8662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0148451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1223G0001XOtherGENERAL DENTIST