| Dmitry Karagodsky Pc | |
|
1775 Street Rd Southampton PA 18966-4564 | |
| (215) 969-2001 | |
| Not Available |
| Full Name | Dmitry Karagodsky Pc |
|---|---|
| Speciality | Dentist |
| Location | 1775 Street Rd, Southampton, Pennsylvania |
| Authorized Official Name and Position | Dmitry Karagodsky (AUTHORIZED OFFICIAL, DOCTOR) |
| Authorized Official Contact | 2159692015 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dmitry Karagodsky Pc 1775 Street Rd Southampton PA 18966-4564 Ph: (215) 969-2001 | Dmitry Karagodsky Pc 1775 Street Rd Southampton PA 18966-4564 Ph: (215) 969-2001 |
| NPI Number | 1316711922 |
|---|---|
| Provider Enumeration Date | 11/14/2023 |
| Last Update Date | 11/14/2023 |
| Medicare PECOS PAC ID | 7113375312 |
|---|---|
| Medicare Enrollment ID | O20231129000579 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316711922 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| Provider Name | Dmitry Karagodsky |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1992909261 PECOS PAC ID: 8022466226 Enrollment ID: I20231129000630 |
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