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Individual

THIAN SRISURAPOL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
13346 1ST AVE NE, SEATTLE, WA 98125-3036
(206) 523-6327
Mailing address
12819 RENTON AVE S, SEATTLE, WA 98178-4849
(480) 326-3140

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
0401414951
VA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
0401414951
VA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
31290
TX
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DE60574845
WA

Other

Enumeration date
07/26/2013
Last updated
09/10/2020
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