Provider Demographics
NPI:1265617237
Name:KOUGENTAKIS, GEORGIA (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:GEORGIA
Middle Name:
Last Name:KOUGENTAKIS
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 NATIONAL DR
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6836
Mailing Address - Country:US
Mailing Address - Phone:917-981-5103
Mailing Address - Fax:
Practice Address - Street 1:2420 NATIONAL DR
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-6836
Practice Address - Country:US
Practice Address - Phone:917-981-5103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0536411223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics