Provider Demographics
NPI:1235975004
Name:APIRUGNUNCHAI, MAYVADEE (DDS)
Entity type:Individual
Prefix:
First Name:MAYVADEE
Middle Name:
Last Name:APIRUGNUNCHAI
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 1:523 COLUMBUS AVE APT E
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-3431
Mailing Address - Country:US
Mailing Address - Phone:857-891-3258
Mailing Address - Fax:
Practice Address - Street 1:635 ALBANY ST APT E
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-3550
Practice Address - Country:US
Practice Address - Phone:617-358-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL1000241223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics