Provider Demographics
NPI:1669650750
Name:SURYA P. DHAKAR, D.D.S., P.C.
Entity Type:Organization
Organization Name:SURYA P. DHAKAR, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SURYA
Authorized Official - Middle Name:P
Authorized Official - Last Name:DHAKAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-217-9820
Mailing Address - Street 1:4440 SPRINGFIELD RD STE 101
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3410
Mailing Address - Country:US
Mailing Address - Phone:804-217-9820
Mailing Address - Fax:804-217-9822
Practice Address - Street 1:4440 SPRINGFIELD RD STE 101
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3410
Practice Address - Country:US
Practice Address - Phone:804-217-9820
Practice Address - Fax:804-217-9822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410078122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA817248OtherOTHER
VA14534OtherOTHER