Individual provider · Type 1 NPI

Watchariyaporn Thasai

Dentist · Chicago, IL

NPI number 1417823501 Active

Practice location

4901 N Kedzie Ave
Chicago, IL 60625-5009

Call (773) 895-9202 Map

Mailing address

404 E Clark St Apt 109
Champaign, IL 61820-5208

Specialties and licenses

TaxonomyCodeLicense
Dentist Primary 122300000X019035849 (IL)

Dentist: A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requiremen…

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About NPI 1417823501

Watchariyaporn Thasai's National Provider Identifier is 1417823501, issued on Oct 15, 2025. The primary taxonomy on file is Dentist (122300000X), and the practice location is in Chicago, IL. The record was last updated on Dec 8, 2025.