Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 008970 | CT |
NPI | 1154542819 |
---|---|
Provider Name | Dr. Patchanee Rungruanganunt |
First Address | Farmington, CT 06030-2820 |
Second Address | Farmington, CT 06030-2820 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 08/07/2007 |