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General NPI Number Information
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NPI Number | 1962888354
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Entity Type | Individual
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Provider Name | PACHAREE KULWATTANAPORN D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 08/07/2015
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Last Update Date | 08/07/2015
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Provider Practice Location Address
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Address Line | 18303 E 10 MILE RD SUITE 150
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City | ROSEVILLE
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State | MI
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Zip | 48066-4988
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Country | US
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Telephone | 586-773-2000
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Fax | 586-773-0408
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Provider Business Mailing Address
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Address Line | 35300 WOODWARD AVE APT 302
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City | BIRMINGHAM
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State | MI
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Zip | 48009-0952
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Country | US
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Telephone | 215-601-9674
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 2901021695
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License Number State | MI
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