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General NPI Number Information
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NPI Number | 1639964489
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Entity Type | Individual
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Provider Name | CHANOAN SUMONTHEE DDS
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Gender | Male
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Dates
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Enumeration Date | 04/11/2025
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 400 W ALLEGHENY AVE STE B1
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City | PHILADELPHIA
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State | PA
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Zip | 19133-3614
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Country | US
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Telephone | 215-291-9200
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Fax |
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Provider Business Mailing Address
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Address Line | 17362 SW 32ND LN
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City | MIRAMAR
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State | FL
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Zip | 33029-5590
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Country | US
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Telephone | 954-556-0928
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS045129
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License Number State | PA
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