Healthcare Provider Details

I. General information

NPI: 1205908258
Provider Name (Legal Business Name): SUKAN NIP D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 KING ST SUITE 112
NORTHAMPTON MA
01060-2451
US

IV. Provider business mailing address

243 KING ST SUITE 112
NORTHAMPTON MA
01060-2451
US

V. Phone/Fax

Practice location:
  • Phone: 413-584-5199
  • Fax:
Mailing address:
  • Phone: 413-584-5199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number21237
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: