Provider Demographics
NPI:1508986969
Name:KORATKAR, HARISH (BDS, MS)
Entity Type:Individual
Prefix:DR
First Name:HARISH
Middle Name:
Last Name:KORATKAR
Suffix:
Gender:M
Credentials:BDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 COMO AVE
Mailing Address - Street 2:HEALTHPARTNERS COMO DENTAL SPECIALTY CLINIC
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-1460
Mailing Address - Country:US
Mailing Address - Phone:651-647-2500
Mailing Address - Fax:651-632-8984
Practice Address - Street 1:2500 COMO AVE
Practice Address - Street 2:HEALTHPARTNERS COMO DENTAL SPECIALTY CLINIC
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-1460
Practice Address - Country:US
Practice Address - Phone:925-489-9009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA604001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN263626300OtherMN HEALTH CARE PROGRAM
MN74G72KOOtherBLUE CROSS BLUE SHIELD