Provider Demographics
NPI:1841893906
Name:VARAPONGSITTIKUL, PAKWAN (DDS, MS, FACP)
Entity type:Individual
Prefix:
First Name:PAKWAN
Middle Name:
Last Name:VARAPONGSITTIKUL
Suffix:
Gender:F
Credentials:DDS, MS, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 S 320TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5461
Mailing Address - Country:US
Mailing Address - Phone:206-992-7332
Mailing Address - Fax:
Practice Address - Street 1:2505 S 320TH ST STE 110
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5461
Practice Address - Country:US
Practice Address - Phone:206-992-7332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE610948251223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics