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General NPI Number Information
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NPI Number | 1386399673
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Entity Type | Individual
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Provider Name | PHORNLARP MEKRAKSAKIT DDS, MS
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Gender | Male
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Dates
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Enumeration Date | 02/16/2022
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Last Update Date | 02/16/2022
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Provider Practice Location Address
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Address Line | 1400 E EXPRESSWAY 83 STE 155
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City | MCALLEN
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State | TX
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Zip | 78503-1793
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Country | US
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Telephone | 956-630-6166
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Fax |
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Provider Business Mailing Address
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Address Line | 4200 N CHAI ST APT 904
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City | MCALLEN
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State | TX
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Zip | 78504-0527
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Country | US
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Telephone | 314-250-6651
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 38103
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License Number State | TX
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