Provider Demographics
NPI:1760530943
Name:GEORGE KOURAKIN DMD, PA
Entity Type:Organization
Organization Name:GEORGE KOURAKIN DMD, PA
Other - Org Name:MY DENTIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:GEORGI
Authorized Official - Last Name:KOURAKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-825-0618
Mailing Address - Street 1:16 W VINE ST
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-3823
Mailing Address - Country:US
Mailing Address - Phone:856-825-0618
Mailing Address - Fax:856-825-3420
Practice Address - Street 1:16 W VINE ST
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-3823
Practice Address - Country:US
Practice Address - Phone:856-825-0618
Practice Address - Fax:856-825-3420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD130651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty