Provider Demographics
NPI:1205908258
Name:NIP, SUKAN (DDS)
Entity type:Individual
Prefix:DR
First Name:SUKAN
Middle Name:
Last Name:NIP
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 KING ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2451
Mailing Address - Country:US
Mailing Address - Phone:413-584-5199
Mailing Address - Fax:
Practice Address - Street 1:243 KING ST
Practice Address - Street 2:SUITE 112
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2451
Practice Address - Country:US
Practice Address - Phone:413-584-5199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA212371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice