Provider Demographics
NPI:1164592259
Name:ATTAPHITAYA, SURAT (DMD)
Entity Type:Individual
Prefix:DR
First Name:SURAT
Middle Name:
Last Name:ATTAPHITAYA
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 1:900 E PROSPECT AVE
Mailing Address - Street 2:STE 800
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-1600
Mailing Address - Country:US
Mailing Address - Phone:580-765-2000
Mailing Address - Fax:580-765-2001
Practice Address - Street 1:900 E PROSPECT AVE
Practice Address - Street 2:STE 800
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1600
Practice Address - Country:US
Practice Address - Phone:580-765-2000
Practice Address - Fax:580-765-2001
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA549861223X0400X
OK1841223X0400X
TX220541223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics