Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 58 | MD |
NPI | 1174893580 |
---|---|
Provider Name | Dr. Penwadee Limkangwalmongkol |
First Address | Baltimore, MD 21201 |
Second Address | Baltimore, MD 21201-1510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2012 |
Last Update Date | 03/01/2012 |