Individual
HARRY J KOUTROULAKIS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
1 PLAZA DR, LUGOFF, SC 29078-9384
(803) 438-3540
Mailing address
1 PLAZA DR, LUGOFF, SC 29078-9384
(803) 438-3540
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2807
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Z2807
—
SC
Enumeration date
11/23/2005
Last updated
07/08/2007
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