Provider Demographics
NPI:1073297370
Name:CHAROENKITKARN, PRACHAYA (DMD)
Entity Type:Individual
Prefix:
First Name:PRACHAYA
Middle Name:
Last Name:CHAROENKITKARN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 MALDEN ST APT 222
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2889
Mailing Address - Country:US
Mailing Address - Phone:312-874-9010
Mailing Address - Fax:
Practice Address - Street 1:636 MAIN ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-0062
Practice Address - Country:US
Practice Address - Phone:007-278-1944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859778122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist