Provider Demographics
NPI:1861701674
Name:SURAPANENI, SWATI (DMD)
Entity type:Individual
Prefix:DR
First Name:SWATI
Middle Name:
Last Name:SURAPANENI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2533 OLD TAVERN RD
Mailing Address - Street 2:APT 5
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1070
Mailing Address - Country:US
Mailing Address - Phone:630-776-1513
Mailing Address - Fax:
Practice Address - Street 1:1264B N LAKE ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-2453
Practice Address - Country:US
Practice Address - Phone:630-801-9028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028506122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist