Provider Demographics
NPI:1255655858
Name:SRABIAN, JOHNNY SUREN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:SUREN
Last Name:SRABIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:SUREN
Other - Last Name:SRABIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:370 BIRCHWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:NC
Mailing Address - Zip Code:28906-9047
Mailing Address - Country:US
Mailing Address - Phone:239-823-2801
Mailing Address - Fax:
Practice Address - Street 1:370 BIRCHWOOD CIR
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906-9047
Practice Address - Country:US
Practice Address - Phone:239-823-2801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901011131122300000X
FLDN9489122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist