Individual
DR. ATHANASIOS PANAGIOTIS KAKOURAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
11020 S TRYON ST, SUITE 401, CHARLOTTE, NC 28273-6530
(704) 504-8070
Mailing address
3700 STOKES AVE, CHARLOTTE, NC 28210-4748
(704) 281-9991
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7838
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89902XJ
—
NC
01
—
902XJ
BLUECROSS/BLUESHIELD
NC
Enumeration date
09/08/2005
Last updated
02/18/2009
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