Provider Demographics
NPI:1720154792
Name:KRITSANACHAIWANICH, KARN (DDS)
Entity type:Individual
Prefix:DR
First Name:KARN
Middle Name:
Last Name:KRITSANACHAIWANICH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 W BEN WHITE BLVD
Mailing Address - Street 2:SUITE 112-B
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-6888
Mailing Address - Country:US
Mailing Address - Phone:512-326-2066
Mailing Address - Fax:512-326-2955
Practice Address - Street 1:1221 W BEN WHITE BLVD
Practice Address - Street 2:SUITE 112-B
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-6888
Practice Address - Country:US
Practice Address - Phone:512-326-2066
Practice Address - Fax:512-326-2955
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX176731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice