Provider Demographics
NPI:1275223505
Name:JINDAROJANAKUL, APISSADA
Entity Type:Individual
Prefix:MISS
First Name:APISSADA
Middle Name:
Last Name:JINDAROJANAKUL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HARVARD DENTAL CENTER
Mailing Address - Street 2:188 LONGWOOD AVE.
Mailing Address - City:BOSTON
Mailing Address - State:ME
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-432-1434
Mailing Address - Fax:
Practice Address - Street 1:HARVARD DENTAL CENTER
Practice Address - Street 2:188 LONGWOOD AVE.
Practice Address - City:BOSTON
Practice Address - State:ME
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-432-1434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MADL15760122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program