Provider Demographics
NPI:1275204380
Name:SUVARNA, SHIVANI C (BDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:SHIVANI
Middle Name:C
Last Name:SUVARNA
Suffix:
Gender:F
Credentials:BDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 BRITTANY FARMS RD # J237
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-1267
Mailing Address - Country:US
Mailing Address - Phone:206-612-5764
Mailing Address - Fax:
Practice Address - Street 1:263 FARMINGTON AVE DEPT OF RECONSTRUCTIVE SCIENCES
Practice Address - Street 2:L7045
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-0001
Practice Address - Country:US
Practice Address - Phone:860-679-2649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61086406122300000X, 1223P0700X
CT132801223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist