Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 30218 | IA |
NPI | 1134334782 |
---|---|
Provider Name | Dr. Roongkit Ron Leehacharoenkul |
First Address | Iowa City, IA 52242 |
Second Address | Iowa City, IA 52242 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 08/07/2007 |