Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 21159 | TX |
NPI | 1033228978 |
---|---|
Provider Name | Dr. Supakit Peanchitlertkajorn |
First Address | Dallas, TX 75235-0408 |
Second Address | Dallas, TX 75235-5259 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |