Provider Demographics
NPI:1013388024
Name:PATTANAPROMMAS, VALITSINEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:VALITSINEE
Middle Name:
Last Name:PATTANAPROMMAS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 MAPLE AVE
Mailing Address - Street 2:APT 19
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-1608
Mailing Address - Country:US
Mailing Address - Phone:951-505-0607
Mailing Address - Fax:
Practice Address - Street 1:342 WINCHESTER ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3936
Practice Address - Country:US
Practice Address - Phone:866-604-2413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-16
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH041891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice