# SUPRITHA NILAM

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1629597562
- **Gender:** F
- **Credential:** DDS

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DEN4589 | ME | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 30.027873 | OH | — |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | 106194 | CA | — |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | 30.027873 | OH | Yes |

## Other

- **Enumeration date:** 09/12/2017
- **Last updated:** 05/12/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0139624 | — | OH |
| 05 | — | 300130293 | — | IN |
| 05 | — | 7101055250 | — | KY |