Provider Demographics
NPI:1578177697
Name:ODHAV, SURINA
Entity Type:Individual
Prefix:
First Name:SURINA
Middle Name:
Last Name:ODHAV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8711 LINKMEADOW LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-3507
Mailing Address - Country:US
Mailing Address - Phone:832-282-6015
Mailing Address - Fax:
Practice Address - Street 1:4818 WATERVIEW TOWN CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-2384
Practice Address - Country:US
Practice Address - Phone:281-916-5285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36653122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist