Dr. Supontep Teerakanok, DDS
Dentist, Periodontics in Boston, MA. Individual provider (NPI-1).
NPI number1871134833
StatusActive
Last updated in NPPESOct 1, 2019
Details
- NPI
- 1871134833
- Entity type
- Individual (NPI-1)
- Name
- Dr. Supontep Teerakanok
- Credential
- DDS
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Oct 1, 2019
- Last updated
- Oct 1, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223P0300X | Dentist, Periodontics | DL14138 | MA | Yes |
Practice location
Henry Goldman School Of Dental Medicine635 Albany St
Boston, MA 02118
Phone 617-763-7550
Mailing address
18 Elba StBrookline, MA 02446-6759
Phone 617-763-7550
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