Provider Demographics
NPI:1023451911
Name:SINGRATANAKUL, ANISSA (DMD)
Entity type:Individual
Prefix:DR
First Name:ANISSA
Middle Name:
Last Name:SINGRATANAKUL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3860
Mailing Address - Country:US
Mailing Address - Phone:775-530-1837
Mailing Address - Fax:
Practice Address - Street 1:1231 WILLIAM D TATE AVE STE 400
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8674
Practice Address - Country:US
Practice Address - Phone:817-421-4030
Practice Address - Fax:817-421-4030
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28541122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist