Organization
SUPAKIT PEANCHITLERTKAJORN DENTAL COORPORATION
Active
Other names
Hayward Braces
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUPAKIT PEANCHITLERTKAJORN (OWNER)
(510) 581-7851
Entity
Organization
Contact information
Practice address
1866 B ST STE 201, HAYWARD, CA 94541-3139
(510) 581-7851
Mailing address
1866 B ST STE 201, HAYWARD, CA 94541-3139
(510) 581-7851
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
56947
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1033228978
—
TX
Enumeration date
08/31/2011
Last updated
08/31/2011
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