Provider Demographics
NPI:1508176942
Name:GOEL, SURUCHI (DDS)
Entity Type:Individual
Prefix:
First Name:SURUCHI
Middle Name:
Last Name:GOEL
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 1:9 LEE CT
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10805-1418
Mailing Address - Country:US
Mailing Address - Phone:573-529-1614
Mailing Address - Fax:
Practice Address - Street 1:2 GLEN HILL RD
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-4906
Practice Address - Country:US
Practice Address - Phone:203-797-9392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT010313122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist