Provider Demographics
NPI:1760565030
Name:KARAVOLAS, CHRISTIAN MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:MARK
Last Name:KARAVOLAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:KARAVOLAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:20 HOPE AVE
Mailing Address - Street 2:#306
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453
Mailing Address - Country:US
Mailing Address - Phone:781-647-0804
Mailing Address - Fax:781-647-6730
Practice Address - Street 1:20 HOPE AVE
Practice Address - Street 2:#306
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453
Practice Address - Country:US
Practice Address - Phone:781-647-0804
Practice Address - Fax:781-647-6730
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA185481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice