Provider Demographics
NPI:1962630400
Name:PORAMAPORNPILAS, KATY (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATY
Middle Name:
Last Name:PORAMAPORNPILAS
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 1:1737 MARAVILLA DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-2057
Mailing Address - Country:US
Mailing Address - Phone:281-507-3044
Mailing Address - Fax:
Practice Address - Street 1:28404 HIGHWAY 290 STE G03
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-5474
Practice Address - Country:US
Practice Address - Phone:281-849-8733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00247651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice