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Individual
SOMSAK SITTITAVORNWONG
Active
Individual
SOMSAK SITTITAVORNWONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
D5778
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009910983
—
AL
05
—
009910984
—
AL
05
—
009910986
—
AL
05
—
009910988
—
AL
01
—
051542567
BCBS
AL
01
—
051542572
BCBS
AL
01
—
051542573
BCBS
AL
01
—
051542574
BCBS
AL
Enumeration date
05/16/2006
Last updated
02/26/2020
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