Provider Demographics
NPI:1053046615
Name:SWAMPILLAI, SUREN (DDS)
Entity Type:Individual
Prefix:
First Name:SUREN
Middle Name:
Last Name:SWAMPILLAI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 PROPRIETORS DR UNIT 12
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-2193
Mailing Address - Country:US
Mailing Address - Phone:781-837-3700
Mailing Address - Fax:
Practice Address - Street 1:3 PROPRIETORS DR UNIT 12
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-2193
Practice Address - Country:US
Practice Address - Phone:781-837-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18597091223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223G0001XDental ProvidersDentistGeneral Practice