Veeranna, Supreeth L

Veeranna, Supreeth L is an individual health care provider with primary practice located at 74 Elmcrest Dr , Chicopee MA 01013-3339. He recently has 2 registered licenses in different health care specialties including Dental Providers / General Practice, Dental Providers / Pediatric Dentistry. Dental Providers / Pediatric Dentistry is his primary health care specialty. Veeranna, Supreeth L can be contacted via phone (617) 275-3216.

Contact Information

Primary practice address
74 Elmcrest Dr Chicopee MA 01013-3339
Phone: (617) 275-3216
Fax: (617) 275-3216
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 30-022310 Ohio
Dental Providers / Pediatric Dentistry 1223P0221X DN21274 Massachusetts
Dental Providers / Pediatric Dentistry 1223P0221X 10818 Connecticut

Profile Details

NPI number 1164471363
LBN Legal business name Veeranna, Supreeth L
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date May 8th, 2006
Last updated May 31st, 2013 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164471363 NPPES
Ohio MEDICAID 2636722
Ohio MEDICAID 110008505A

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