Provider Demographics
NPI:1710505599
Name:SURESH, UTTARA
Entity Type:Individual
Prefix:DR
First Name:UTTARA
Middle Name:
Last Name:SURESH
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 1:1911 HOLCOMBE BLVD APT 1416
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4189
Mailing Address - Country:US
Mailing Address - Phone:716-480-5367
Mailing Address - Fax:
Practice Address - Street 1:3702 CENTER ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:TX
Practice Address - Zip Code:77536-6104
Practice Address - Country:US
Practice Address - Phone:832-460-1896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36293122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist