Phennatda Polpornvitoon

NPI #1568082030 in Port Charlotte, Florida

Provider Information

NPI Number: 1568082030
Entity Type: Individual
Name: Phennatda Polpornvitoon
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dentist - General Practice
Enumeration Date: Apr 24, 2020
Last Updated: Jun 10, 2022

Practice Location

Address: 18000 TOLEDO BLADE BLVD
City: Port Charlotte
State: Florida
ZIP Code: 33948-1980
Phone: (941) 740-8598

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X
Dentist - General Practice — General Practice	1223G0001X	Primary

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