Provider Demographics
NPI:1366636524
Name:JAMES SURDILLA DDS
Entity Type:Organization
Organization Name:JAMES SURDILLA DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SURDILLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-633-8848
Mailing Address - Street 1:10929 SOUTH ST STE 114B
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-5365
Mailing Address - Country:US
Mailing Address - Phone:562-924-2711
Mailing Address - Fax:562-924-0288
Practice Address - Street 1:3557 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-4519
Practice Address - Country:US
Practice Address - Phone:562-633-8848
Practice Address - Fax:562-633-6303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA465291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD46529OtherDENTI-CAL