IndividualActive
Watchariyaporn Thasai
NPI 1417823501 · Dentist · Chicago, IL
Provider details
- NPI number
- 1417823501
- Entity type
- Individual
- Primary specialty
- DentistDental Providers
- Sex
- Female
- Sole proprietor
- Yes
- License
- 019035849 (IL)
Specialties & taxonomies
Dental Providers
Profile Score
Established profile(54/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
Under 1 yr in registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
4901 N Kedzie Ave
Chicago, IL 60625-5009
Phone: (773) 895-9202
Street-level locationGet directions
Mailing address
404 E Clark St Apt 109
Champaign, IL 61820-5208
Registry dates
- Enumerated
- 2025-10-15
- Last updated
- 2025-12-08
- Certified
- 2025-12-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.