Provider Demographics
NPI:1417337502
Name:SURESH, RISHI (DDS)
Entity Type:Individual
Prefix:DR
First Name:RISHI
Middle Name:
Last Name:SURESH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43087 GOLF VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH RIDING
Mailing Address - State:VA
Mailing Address - Zip Code:20152-5313
Mailing Address - Country:US
Mailing Address - Phone:703-501-5411
Mailing Address - Fax:
Practice Address - Street 1:7800 SUDLEY RD STE 7810
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-2804
Practice Address - Country:US
Practice Address - Phone:703-367-0599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401415482122300000X, 122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes122300000XDental ProvidersDentist