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General NPI Number Information
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NPI Number | 1144576737
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Entity Type | Organization
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Legal Business Name | SIRIN THANASASAVAT DMD PA
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Dates
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Enumeration Date | 08/01/2012
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Last Update Date | 08/01/2012
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Provider Practice Location Address
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Address Line | 8010 SUNPORT DR STE 115
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City | ORLANDO
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State | FL
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Zip | 32809-7897
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Country | US
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Telephone | 407-412-7887
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Fax | 407-641-8932
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Provider Business Mailing Address
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Address Line | 8010 SUNPORT DR STE 115
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City | ORLANDO
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State | FL
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Zip | 32809-7897
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Country | US
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Telephone | 407-412-7887
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Fax | 407-641-8932
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Authorized Official
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Title or Position | PRESIDENT
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Name | SIRIN THANASASAVAT
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Credential | D.M.D
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Telephone | 407-929-7095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN17989
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License Number State | FL
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