Before he started practicing in Clearwater Florida in 2013, he practiced in central Washington at a large multi-clinic facility where he also served as an Assistant Professor of Clinical Dentistry at Northwest Dental Residency Program, treating a wide range of patients from all walks of life while also teaching new dentists advanced skills. Holding true to form, Dr. Karunagaran also served as an affiliate faculty member for both the University of Washington, School of Dentistry and for the Oregon Health and Sciences University, School of Dentistry. While he was in Washington State, he also held a medical staff position at Yakima Valley Memorial Hospital, where he treated developmentally disabled patients under general anesthesia. 

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He is one of the very few implant dentists in the US, who is currently providing Zirconia dental implants for the patients in his practice. He is also an active member of the International Academy of Ceramic Implantology.