Healthcare Provider Details

I. General information

NPI: 1912188947
Provider Name (Legal Business Name): JANANYA PLIANRUNGSI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3245 GARDEN STREET
TITUSVILLE FL
32796
US

IV. Provider business mailing address

2502 N ROCKY POINT DR SUITE- 1000
TAMPA FL
33607-1421
US

V. Phone/Fax

Practice location:
  • Phone: 321-269-2700
  • Fax:
Mailing address:
  • Phone: 813-288-1999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN17391
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: