Provider Demographics
NPI:1376372821
Name:SUAYSOMPOL, NATTHARAT (DMD)
Entity type:Individual
Prefix:
First Name:NATTHARAT
Middle Name:
Last Name:SUAYSOMPOL
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 1:2405 MORGAN BAY CT
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-3953
Mailing Address - Country:US
Mailing Address - Phone:832-455-3971
Mailing Address - Fax:
Practice Address - Street 1:1780 S FRIENDSWOOD DR
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-5410
Practice Address - Country:US
Practice Address - Phone:281-992-0038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX408771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice