Provider Demographics
NPI:1134334782
Name:LEEHACHAROENKUL, ROONGKIT RON (DDS)
Entity type:Individual
Prefix:DR
First Name:ROONGKIT
Middle Name:RON
Last Name:LEEHACHAROENKUL
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 1:418 DENTAL SCIENCE BLDG SOUTH
Mailing Address - Street 2:DEPT OF PROSTHODONTICS, COLLEGE OF DENTISTRY
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242
Mailing Address - Country:US
Mailing Address - Phone:319-335-7275
Mailing Address - Fax:
Practice Address - Street 1:418 DENTAL SCIENCE BLDG SOUTH
Practice Address - Street 2:DEPT OF PROSTHODONTICS, COLLEGE OF DENTISTRY
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242
Practice Address - Country:US
Practice Address - Phone:319-335-7275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA302181223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics