Provider Demographics
NPI:1417066325
Name:ORTHODONTICS FOR INFANTS AND CHILDREN
Entity Type:Organization
Organization Name:ORTHODONTICS FOR INFANTS AND CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:SUPAKIT
Authorized Official - Middle Name:
Authorized Official - Last Name:PEANCHITLERTKAJORN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MDS
Authorized Official - Phone:214-456-8825
Mailing Address - Street 1:PO BOX 35408
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-0408
Mailing Address - Country:US
Mailing Address - Phone:214-456-8825
Mailing Address - Fax:214-456-8256
Practice Address - Street 1:6300 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-5259
Practice Address - Country:US
Practice Address - Phone:214-456-8825
Practice Address - Fax:214-456-8256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty