Provider Demographics
NPI:1558633701
Name:KAKIS, PETER WALDEMARS (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:WALDEMARS
Last Name:KAKIS
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 1:295 E WHITTIER ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206-2389
Mailing Address - Country:US
Mailing Address - Phone:614-443-9717
Mailing Address - Fax:614-443-9717
Practice Address - Street 1:295 E WHITTIER ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43206-2389
Practice Address - Country:US
Practice Address - Phone:614-443-9717
Practice Address - Fax:614-443-9717
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist