Provider Demographics
NPI:1598965824
Name:RATANATHARATHORN, KONGKIAT (DDS)
Entity Type:Individual
Prefix:DR
First Name:KONGKIAT
Middle Name:
Last Name:RATANATHARATHORN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 32ND AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-3241
Mailing Address - Country:US
Mailing Address - Phone:099-586-2220
Mailing Address - Fax:
Practice Address - Street 1:3838 BRIDGEPORT WAY W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4416
Practice Address - Country:US
Practice Address - Phone:253-212-3430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55922122300000X
WADE60748920122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentist