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General NPI Number Information
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NPI Number | 1164471363
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Entity Type | Individual
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Provider Name | SUPREETH L VEERANNA
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Gender | Male
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 05/31/2013
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Provider Practice Location Address
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Address Line | 74 ELMCREST DR
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City | CHICOPEE
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State | MA
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Zip | 01013-3339
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Country | US
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Telephone | 617-275-3216
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Fax | 617-275-3216
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Provider Business Mailing Address
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Address Line | 74 ELMCREST DR
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City | CHICOPEE
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State | MA
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Zip | 01013-3339
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Country | US
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Telephone | 617-275-3216
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Fax | 617-275-3216
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30-022310
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN21274
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 10818
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License Number State | CT
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