Provider Demographics
NPI:1508014036
Name:TALUNGCHIT, SUPITCHA (DDS)
Entity Type:Individual
Prefix:
First Name:SUPITCHA
Middle Name:
Last Name:TALUNGCHIT
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 1:1022 NEWTON ROAD
Mailing Address - Street 2:APT #1
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246
Mailing Address - Country:US
Mailing Address - Phone:319-621-0863
Mailing Address - Fax:
Practice Address - Street 1:NEWTON ROAD
Practice Address - Street 2:S229 DSB THE UNIVERSITY OF IOWA
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52246
Practice Address - Country:US
Practice Address - Phone:319-335-7338
Practice Address - Fax:319-335-7218
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA30229122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist