MEDICARE: PATHAMAS CHANTARACHERD MITTMAN DDS, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X2210X	Orofacial Pain Dentistry	S187	MN

General Provider Information

NPI Number	:	1447972922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATHAMAS CHANTARACHERD MITTMAN DDS, MS

Provider Business Mailing Address
First Line	:	3475 PLYMOUTH BLVD STE 200
Second Line	:
City	:	PLYMOUTH
State	:	MN
Zip	:	55447-1539
Country	:	US
Telephone Number	:	763-577-2484
Fax Number	:	763-577-1375

Provider Business Practice Location Address
First Line	:	3475 PLYMOUTH BLVD STE 200
Second Line	:
City	:	PLYMOUTH
State	:	MN
Zip	:	55447-1539
Country	:	US
Telephone Number	:	763-577-2484
Fax Number	:	763-577-1375

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2022
Last Update Date	:	09/13/2022

Similar Medicare Providers

1639103682 — JAMES R FRICTON DDS
Practice Location Address:

3475 PLYMOUTH BLVD STE 200
PLYMOUTH, MN
55447-1539

Practice Phone: 763-577-2484
Practice Fax:

1043409170 — LORI L SANDBERG PT
Practice Location Address:

3475 PLYMOUTH BLVD STE 200
PLYMOUTH, MN
55447-1539

Practice Phone: 763-577-2484
Practice Fax:

1285368514 — MINNESOTA PAIN PREVENTION CLINIC, P.A.
Practice Location Address:

3475 PLYMOUTH BLVD STE 200
MINNEAPOLIS, MN
55447-1539

Practice Phone: 612-619-1678
Practice Fax:

1780722264 — MR. MASTON JOHN YEE
Practice Location Address:

34393 PLYMOUTH RD
LIVONIA, MI
48150-1539

Practice Phone: 734-522-6500
Practice Fax: 734-522-6510

1700104270 — ROYAL OPTICS
Practice Location Address:

34393 PLYMOUTH RD
LIVONIA, MI
48150-1539

Practice Phone: 734-522-6500
Practice Fax: 734-522-6510

1588033252 — SARANYA VARUN BDS, MDS
Practice Location Address:

675 E NICOLLET BLVD STE 255
BURNSVILLE, MN
55337-6768

Practice Phone: 952-892-6222
Practice Fax: 952-892-6477

Directions to “ PATHAMAS CHANTARACHERD MITTMAN DDS, MS” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.