Provider Demographics
NPI:1447558150
Name:THAMMASITHIBOON, IRENE (DDS)
Entity Type:Individual
Prefix:MS
First Name:IRENE
Middle Name:
Last Name:THAMMASITHIBOON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 N. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:FORT STOCKTON
Mailing Address - State:TX
Mailing Address - Zip Code:79735
Mailing Address - Country:US
Mailing Address - Phone:432-336-6466
Mailing Address - Fax:432-336-8248
Practice Address - Street 1:713 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT STOCKTON
Practice Address - State:TX
Practice Address - Zip Code:79735
Practice Address - Country:US
Practice Address - Phone:432-336-6466
Practice Address - Fax:432-336-8248
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00259691223G0001X
TX259691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice