Provider Demographics
NPI:1437185766
Name:SURI, AJAY (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:AJAY
Middle Name:
Last Name:SURI
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 241534
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-0010
Mailing Address - Country:US
Mailing Address - Phone:501-821-5859
Mailing Address - Fax:501-588-3455
Practice Address - Street 1:36 RAHLING CIR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-9191
Practice Address - Country:US
Practice Address - Phone:501-821-5859
Practice Address - Fax:501-588-3455
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3513 / 1091223X0400X
TX209011223X0400X
LA74931223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR164867608Medicaid