Individual
CHARLES TZAGOURNIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
393 E TOWN ST, SUITE 117, COLUMBUS, OH 43215-4741
(614) 224-4039
(614) 224-4039
Mailing address
393 E TOWN ST, SUITE 117, COLUMBUS, OH 43215-4741
(614) 224-4039
(614) 224-4039
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
12995
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0133215
—
OH
01
—
310791883026
CARESOURCE
OH
01
—
605886
COMPDENT
OH
Enumeration date
09/06/2006
Last updated
07/09/2007
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