Provider Demographics
NPI:1710216718
Name:CHUTINAN, SUPATTRIYA (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:SUPATTRIYA
Middle Name:
Last Name:CHUTINAN
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 CAPTAIN EAMES CIR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721-1980
Mailing Address - Country:US
Mailing Address - Phone:508-881-5702
Mailing Address - Fax:
Practice Address - Street 1:188 LONGWOOD AVE # REB224
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5819
Practice Address - Country:US
Practice Address - Phone:617-432-4460
Practice Address - Fax:617-432-0101
Is Sole Proprietor?:No
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADF10597122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist