Individual
SUPREETH L VEERANNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
74 ELMCREST DR, CHICOPEE, MA 01013-3339
(617) 275-3216
(617) 275-3216
Mailing address
74 ELMCREST DR, CHICOPEE, MA 01013-3339
(617) 275-3216
(617) 275-3216
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
30-022310
OH
1223P0221X
Pediatric Dentistry
10818
CT
1223P0221X
Pediatric Dentistry
Primary
DN21274
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110008505A
—
MA
05
—
2636722
—
OH
Enumeration date
05/08/2006
Last updated
05/31/2013
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