Provider Demographics
NPI:1265400519
Name:SUPPLIES, SVEN (DMD)
Entity type:Individual
Prefix:
First Name:SVEN
Middle Name:
Last Name:SUPPLIES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 GRIST MILL RD
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01460-2255
Mailing Address - Country:US
Mailing Address - Phone:978-486-8647
Mailing Address - Fax:
Practice Address - Street 1:179 GREAT RD
Practice Address - Street 2:SUITE 206
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-5777
Practice Address - Country:US
Practice Address - Phone:978-263-8358
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA189561223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics