Individual
DR. ALI POOTRAKUL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
052450
NY
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
60258
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02891830
—
NY
Enumeration date
01/12/2007
Last updated
11/18/2019
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