Provider Demographics
NPI:1790727527
Name:KOKINOS, CHARLES A (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:A
Last Name:KOKINOS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-2622
Mailing Address - Country:US
Mailing Address - Phone:978-454-7791
Mailing Address - Fax:978-453-8730
Practice Address - Street 1:54 CHURCH ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-2622
Practice Address - Country:US
Practice Address - Phone:978-454-7791
Practice Address - Fax:978-453-8730
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA122611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice