Individual
SUDARAT KIAT-AMNUAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
1515 HOLCOMBE BLVD, HOUSTON, TX 77030-4009
(713) 792-6161
Mailing address
PO BOX 4439, HOUSTON, TX 77210-4439
(713) 792-2991
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
F-21641
TX
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
F-21641
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
166202501
—
TX
01
—
88D830
BCBS
TX
Enumeration date
02/06/2007
Last updated
08/18/2011
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