Provider Demographics
NPI:1033228978
Name:PEANCHITLERTKAJORN, SUPAKIT (DDS, MDS)
Entity Type:Individual
Prefix:DR
First Name:SUPAKIT
Middle Name:
Last Name:PEANCHITLERTKAJORN
Suffix:
Gender:M
Credentials:DDS, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35408
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-0408
Mailing Address - Country:US
Mailing Address - Phone:214-456-8825
Mailing Address - Fax:214-456-8256
Practice Address - Street 1:6300 HARRY HINES BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-5259
Practice Address - Country:US
Practice Address - Phone:214-456-8825
Practice Address - Fax:214-456-8256
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211591223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics