Individual
MISS WICHAYA WISITRASAMEEWONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
188 LONGWOOD AVE, HARVARD SCHOOL OF DENTAL MEDICINE, BOSTON, MA 02115-5819
(617) 432-1452
(617) 432-1897
Mailing address
188 LONGWOOD AVE, HARVARD SCHOOL OF DENTAL MEDICINE, BOSTON, MA 02142
(617) 432-1452
(617) 432-1897
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
DL11966
MA
Other
Enumeration date
08/06/2013
Last updated
08/06/2013
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