Provider Demographics
NPI:1689221830
Name:KARACHUN, BORIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:BORIS
Middle Name:
Last Name:KARACHUN
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 1:1100 BARNUM AVE
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4901
Mailing Address - Country:US
Mailing Address - Phone:203-873-0650
Mailing Address - Fax:203-845-1829
Practice Address - Street 1:1100 BARNUM AVE
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4901
Practice Address - Country:US
Practice Address - Phone:203-873-0650
Practice Address - Fax:203-845-1829
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12606122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist