Individual
DR. CHATCHAVAL PONGSUGREE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4141 W WILSON RD BLDG 1600, INDIAN HEAD, MD 20640-5162
(301) 744-4948
Mailing address
4141 W WILSON RD BLDG 1600, INDIAN HEAD, MD 20640-5162
(301) 744-4948
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401008966
VA
Other
Enumeration date
04/07/2006
Last updated
12/13/2022
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