Provider Demographics
NPI:1437345311
Name:SAHASAKMONTRI, PANIDA (DMD)
Entity Type:Individual
Prefix:DR
First Name:PANIDA
Middle Name:
Last Name:SAHASAKMONTRI
Suffix:
Gender:F
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:PO BOX 939
Mailing Address - Street 2:MACT HEALTH BOARD INC
Mailing Address - City:ANGELS CAMP
Mailing Address - State:CA
Mailing Address - Zip Code:95222-0939
Mailing Address - Country:US
Mailing Address - Phone:209-754-6260
Mailing Address - Fax:209-736-1813
Practice Address - Street 1:5192 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:MARIPOSA
Practice Address - State:CA
Practice Address - Zip Code:95338
Practice Address - Country:US
Practice Address - Phone:209-966-0573
Practice Address - Fax:209-742-6321
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55984122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD59984Medicaid