Individual
DR. MALISSA VACHARAKIAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
6526 GUNN HWY, TAMPA, FL 33625-4022
(813) 374-2290
Mailing address
502 S FREMONT AVE APT 433, TAMPA, FL 33606-4300
(210) 391-6295
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
21729
TX
1223E0200X
Endodontics
Primary
DN16468
FL
Other
Enumeration date
10/23/2006
Last updated
01/01/2016
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