Individual
SOMKAMOL VANICHVATANA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3320 RUTGER ST, SAINT LOUIS, MO 63104-1122
(314) 977-8363
Mailing address
18 S KINGSHIGHWAY BLVD, APT 9S, SAINT LOUIS, MO 63108-1356
(314) 550-6780
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
06/23/2014
Last updated
06/23/2014
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