Provider Demographics
NPI:1649291147
Name:WONGCHUKIT, VANIDA (DDS)
Entity type:Individual
Prefix:DR
First Name:VANIDA
Middle Name:
Last Name:WONGCHUKIT
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 1:4231 LAKE TERRACE CT
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-2326
Mailing Address - Country:US
Mailing Address - Phone:281-403-1342
Mailing Address - Fax:281-403-1342
Practice Address - Street 1:625 FREEPORT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-4083
Practice Address - Country:US
Practice Address - Phone:281-403-1342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice