Provider Demographics
NPI:1386399673
Name:MEKRAKSAKIT, PHORNLARP (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:PHORNLARP
Middle Name:
Last Name:MEKRAKSAKIT
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 N CHAI ST APT 904
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-0527
Mailing Address - Country:US
Mailing Address - Phone:314-250-6651
Mailing Address - Fax:
Practice Address - Street 1:1400 E EXPRESSWAY 83 STE 155
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1793
Practice Address - Country:US
Practice Address - Phone:956-630-6166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX381031223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics