DR. SUPONTEP TEERAKANOK (NPI# 1871134833) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871134833 |
| Entity Type | Individual |
| Full Name | DR. SUPONTEP TEERAKANOK |
| Credential | DDS |
| Practice Address |
Henry Goldman School of Dental Medicine 635 Albany St Boston MA 02118 |
| Mailing Address |
18 Elba St Brookline MA 02446-6759 |
| Practice Telephone | 6177637550 |
| Mailing Telephone | 6177637550 |
| Enumeration Date | 2019-10-01 |
| Last Update Date | 2019-10-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
DL14138 | MA | Dental Providers |
| Street Address |
HENRY GOLDMAN SCHOOL OF DENTAL MEDICINE 635 ALBANY ST |
| City | BOSTON |
| State | MA |
| Zip Code | 02118 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649870023 | Carlos E Salazar | Counselor | Hcrc 23 Bradston St., Boston, MA 02118 | 2020-10-27 |
| 1780292607 | Jinal Gandhi | Student in an Organized Health Care Education/Training Program | Shapiro Primary Care, 725 Albany Street, Boston, MA 02118 | 2020-07-16 |
| 1669094777 | German Eduardo Velez | Student in an Organized Health Care Education/Training Program | One Boston Medical Center Place Boston Medical Center, Boston, MA 02118 | 2020-05-12 |
| 1255969895 | Isabela Medeiros Heringer Pereira | Student in an Organized Health Care Education/Training Program | 670 Albany Stree, 4th Floor, Boston, MA 02118 | 2020-03-30 |
| 1033746466 | Karan Sunil Hingorani | Student in an Organized Health Care Education/Training Program | Shapiro Primary Care, 725 Albany Street, Precepting Room, Boston, MA 02118 | 2020-03-25 |
| 1326672791 | Azza Ahmed | Dentist | 635 Albany St. G-744, Boston, MA 02118 | 2020-02-25 |
| 1538707401 | Jane Margolis | Social Worker | 840 Harrison Ave., Dowling 2 South, Boston, MA 02118 | 2019-12-11 |
| 1750939583 | Qasim Silman Ajmi | Orthopaedic Surgery | Department of Orthopaedic Surgery Boston Medical Center, 850 Harrison Ave Dowling 2 North, Boston, MA 02118 | 2019-08-26 |
| 1922655539 | Jami Ryan Pollard | Physician Assistant | 840 Harrison Avenue, Menino Building, Boston, MA 02118 | 2019-08-20 |
| 1689220097 | Rachel Lynne Maas | Social Worker | 85 East Newton Street, 8th Floor, Suite 802, Boston, MA 02118 | 2019-08-12 |
| Find all providers in zip 02118 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437700218 | Mansour Alasiri | Dentist | 650 Albany St Ste 341, Boston, MA 02118-2518 | 2019-09-24 |
| 1508417338 | Bushra Aljahdali | Dentist | 650 Albany St Fl 3, Boston, MA 02118-2518 | 2019-09-23 |
| 1043863533 | Ricardo Lazaro Pascual | Dentist | 1 Kneeland St Dept, Boston, MA 02111-1527 | 2019-07-23 |
| 1992294979 | Smile Design Boston | Dentist | 21 Custom House St Ste 110, Boston, MA 02110-3525 | 2018-05-06 |
| 1245739291 | Maryam A Alsendi | Dentist | 100 E Newton St Ste G217, Boston, MA 02118-2308 | 2018-02-05 |
| 1528590783 | Rayan Al Edreesi | Dentist | 100 E Netwton St, Suite G-217, Boston, MA 02118 | 2017-03-28 |
| 1013457290 | Majed Khalid M Alshehri | Dentist | 100 East Newton Street Boston, Boston, MA 02118 | 2017-03-07 |
| 1699105734 | Perico Back Bay, LLC | Dentist | 400 Commonwealth Ave. 3rd Flr., Boston, MA 02215 | 2013-11-26 |
| 1639429525 | Majdi Ahmed Aladmawy | Dentist | 1 Kneeland St, Dhs 15, Boston, MA 02111 | 2012-09-18 |
| 1467702373 | Zuhair Natto | Dentist | One Kneeland St, Dhs 15th Floor, Boston, MA 02111 | 2012-09-18 |
| Find all providers in BOSTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.