Individual
DR. SUPONTEP TEERAKANOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
HENRY GOLDMAN SCHOOL OF DENTAL MEDICINE, 635 ALBANY ST, BOSTON, MA 02118
(617) 763-7550
Mailing address
18 ELBA ST, BROOKLINE, MA 02446-6759
(617) 763-7550
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
DL14138
MA
Other
Enumeration date
10/01/2019
Last updated
10/01/2019
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