Provider Demographics
NPI:1134452535
Name:KAMOLPECHARA, PAMELA CHAN (DMD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:CHAN
Last Name:KAMOLPECHARA
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 1:1424 CEDARBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-9457
Mailing Address - Country:US
Mailing Address - Phone:614-271-5005
Mailing Address - Fax:
Practice Address - Street 1:1840 BELL RICHARD AVE
Practice Address - Street 2:BLDG 2157
Practice Address - City:FORT POLK
Practice Address - State:LA
Practice Address - Zip Code:71459-5407
Practice Address - Country:US
Practice Address - Phone:337-531-4854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.023100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist