Provider Demographics
NPI:1407414527
Name:LAOHAKANJANASIRI, PUNYAWAT (DMD)
Entity Type:Individual
Prefix:DR
First Name:PUNYAWAT
Middle Name:
Last Name:LAOHAKANJANASIRI
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 1:12005 SUNRISE VALLEY DR STE 130
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-3468
Mailing Address - Country:US
Mailing Address - Phone:571-446-3554
Mailing Address - Fax:571-464-0198
Practice Address - Street 1:12005 SUNRISE VALLEY DR STE 130
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-3468
Practice Address - Country:US
Practice Address - Phone:571-446-3554
Practice Address - Fax:571-464-0198
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRES.0041191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice