# THIAN SRISURAPOL DDS PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Premier Orthodontics
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528673902
- **Authorized official:** DR. THIAN SRISURAPOL DDS (OWNER/ORTHODONTIST)
- **Authorized official phone:** (480) 326-3140

## Contact information

- **Practice address:** 23535 NE NOVELTY HILL RD \# D308, REDMOND, WA 98053-5502
- **Practice address phone:** (425) 868-7770
- **Practice address fax:** (425) 868-7718
- **Mailing address:** 12819 RENTON AVE S, SEATTLE, WA 98178-4849
- **Mailing address phone:** (480) 326-3140

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 09/11/2020
- **Last updated:** 10/16/2021