Provider Demographics
NPI:1578602660
Name:DANIEL SUR DDS INC DREAM DENTAL CARE
Entity Type:Organization
Organization Name:DANIEL SUR DDS INC DREAM DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TITANIA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-326-0766
Mailing Address - Street 1:1518 NILES STREET
Mailing Address - Street 2:
Mailing Address - City:BAKERFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93305-4806
Mailing Address - Country:US
Mailing Address - Phone:661-326-0766
Mailing Address - Fax:661-326-6482
Practice Address - Street 1:1518 NILES STREET
Practice Address - Street 2:
Practice Address - City:BAKERFIELD
Practice Address - State:CA
Practice Address - Zip Code:93305-4806
Practice Address - Country:US
Practice Address - Phone:661-326-0766
Practice Address - Fax:661-326-6482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA510891223G0001X
CA526321223G0001X
CA511391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9361701OtherDENTI CAL