Provider Demographics
NPI:1417634494
Name:THAKKAR, KARAN
Entity type:Individual
Prefix:
First Name:KARAN
Middle Name:
Last Name:THAKKAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 VALLA CRUCIS LN
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-6733
Mailing Address - Country:US
Mailing Address - Phone:678-575-4084
Mailing Address - Fax:
Practice Address - Street 1:1805 EPPS BRIDGE PKWY STE 101
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6127
Practice Address - Country:US
Practice Address - Phone:706-549-0108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1239561223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program