Provider Demographics
NPI:1396964680
Name:THAMMASITHIBOON, PRASITH (DMD)
Entity type:Individual
Prefix:DR
First Name:PRASITH
Middle Name:
Last Name:THAMMASITHIBOON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 N. MAIN
Mailing Address - Street 2:
Mailing Address - City:FORT STOCKTON
Mailing Address - State:TX
Mailing Address - Zip Code:79735
Mailing Address - Country:US
Mailing Address - Phone:732-336-6466
Mailing Address - Fax:432-336-8248
Practice Address - Street 1:713 N. MAIN
Practice Address - Street 2:
Practice Address - City:FORT STOCKTON
Practice Address - State:TX
Practice Address - Zip Code:79735
Practice Address - Country:US
Practice Address - Phone:732-336-6466
Practice Address - Fax:432-336-8248
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216001223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics