Provider Demographics
NPI:1528673902
Name:THIAN SRISURAPOL DDS PLLC
Entity type:Organization
Organization Name:THIAN SRISURAPOL DDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SRISURAPOL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-326-3140
Mailing Address - Street 1:12819 RENTON AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98178-4849
Mailing Address - Country:US
Mailing Address - Phone:480-326-3140
Mailing Address - Fax:
Practice Address - Street 1:23535 NE NOVELTY HILL RD # D308
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98053-5502
Practice Address - Country:US
Practice Address - Phone:425-868-7770
Practice Address - Fax:425-868-7718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-11
Last Update Date:2021-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental