Provider Demographics
NPI:1922691328
Name:SEMTNER, WIRAWUT THOTHONG (DMD)
Entity Type:Individual
Prefix:DR
First Name:WIRAWUT
Middle Name:THOTHONG
Last Name:SEMTNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:WIRAWUT
Other - Middle Name:
Other - Last Name:THOTHONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:404 S ELM ST STE 108
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-3714
Mailing Address - Country:US
Mailing Address - Phone:918-417-2417
Mailing Address - Fax:
Practice Address - Street 1:404 S ELM ST STE 108
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-3714
Practice Address - Country:US
Practice Address - Phone:918-417-2417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-16
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7688122300000X
FLDN26105122300000X
OK1411223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist