Provider Demographics
NPI:1962888354
Name:KULWATTANAPORN, PACHAREE (DDS)
Entity type:Individual
Prefix:
First Name:PACHAREE
Middle Name:
Last Name:KULWATTANAPORN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35300 WOODWARD AVE
Mailing Address - Street 2:APT 302
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-0952
Mailing Address - Country:US
Mailing Address - Phone:215-601-9674
Mailing Address - Fax:
Practice Address - Street 1:18303 E 10 MILE RD
Practice Address - Street 2:SUITE 150
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4988
Practice Address - Country:US
Practice Address - Phone:586-773-2000
Practice Address - Fax:586-773-0408
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010216951223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics