| Supakit Peanchitlertkajorn Dental Coorporation | |
|
1866 B St Ste 201 Hayward CA 94541-3139 | |
| (510) 581-7851 | |
| Not Available |
| Full Name | Supakit Peanchitlertkajorn Dental Coorporation |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 1866 B St Ste 201, Hayward, California |
| Authorized Official Name and Position | Supakit Peanchitlertkajorn (OWNER) |
| Authorized Official Contact | 5105817851 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Supakit Peanchitlertkajorn Dental Coorporation 1866 B St Ste 201 Hayward CA 94541-3139 Ph: (510) 581-7851 | Supakit Peanchitlertkajorn Dental Coorporation 1866 B St Ste 201 Hayward CA 94541-3139 Ph: (510) 581-7851 |
| NPI Number | 1518248814 |
|---|---|
| Provider Enumeration Date | 08/31/2011 |
| Last Update Date | 08/31/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518248814 | NPI | - | NPPES |
| 1033228978 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 56947 (California) | Primary |
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