Provider Demographics
NPI:1265589519
Name:VEERANNA, SANTHOSH L (DMD)
Entity type:Individual
Prefix:
First Name:SANTHOSH
Middle Name:L
Last Name:VEERANNA
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 1:21 BAY STATE RD
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-1521
Mailing Address - Country:US
Mailing Address - Phone:617-818-6959
Mailing Address - Fax:
Practice Address - Street 1:21 BAY STATE RD
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-1521
Practice Address - Country:US
Practice Address - Phone:413-437-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN213431223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30303580Medicaid
MA0209465Medicaid