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Individual

KAMOLPHOB PHASUK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.D.S.

Contact information

Practice address
11405 PENNSYLVANIA ST STE 110, CARMEL, IN 46032-6905
(317) 574-0866
Mailing address
11405 PENNSYLVANIA ST STE 110, CARMEL, IN 46032-6905

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
12013111A
IN
122300000X
Dentist
38774
TX
1223G0001X
General Practice Dentistry
38774
TX
1223P0700X
Prosthodontics
Primary
12013111A
IN
1223P0700X
Prosthodontics
38774
TX

Other

Enumeration date
05/08/2015
Last updated
12/11/2025
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