Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 40191 | IA |
NPI | 1013463660 |
---|---|
Provider Name | Pantip Henprasert |
First Address | Iowa City, IA 52242-1001 |
Second Address | Iowa City, IA 52242-1001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2016 |
Last Update Date | 08/08/2019 |