Provider Demographics
NPI:1407041437
Name:SURAT ATTAPHITAYA, DMD, MS, PA
Entity Type:Organization
Organization Name:SURAT ATTAPHITAYA, DMD, MS, PA
Other - Org Name:LIFESMILES SMILE CARE AND BRACES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SURAT
Authorized Official - Middle Name:
Authorized Official - Last Name:ATTAPHITAYA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:956-513-0891
Mailing Address - Street 1:4237 N EXPRESSWAY # 77
Mailing Address - Street 2:STE. 1
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-9749
Mailing Address - Country:US
Mailing Address - Phone:956-513-0891
Mailing Address - Fax:956-587-0433
Practice Address - Street 1:4237 N EXPRESSWAY # 77
Practice Address - Street 2:STE. 1
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-9749
Practice Address - Country:US
Practice Address - Phone:956-513-0891
Practice Address - Fax:956-587-0433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX220541223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty