Provider Demographics
NPI:1558597187
Name:SURENDRAN, SWAPNA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SWAPNA
Middle Name:
Last Name:SURENDRAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8117 DUMONT DR APT 101
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-7200
Mailing Address - Country:US
Mailing Address - Phone:703-509-2426
Mailing Address - Fax:
Practice Address - Street 1:8117 DUMONT DR APT 101
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-7200
Practice Address - Country:US
Practice Address - Phone:703-509-2426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037896122300000X
VA0401412881122300000X
DCDEN1000939122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist