Provider Demographics
NPI:1922154301
Name:NAIDU, SURESH K (DDS)
Entity Type:Individual
Prefix:DR
First Name:SURESH
Middle Name:K
Last Name:NAIDU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 DUDLEY ST
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119
Mailing Address - Country:US
Mailing Address - Phone:617-445-7050
Mailing Address - Fax:617-445-7051
Practice Address - Street 1:156 DUDLEY ST
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119
Practice Address - Country:US
Practice Address - Phone:617-445-7050
Practice Address - Fax:617-445-7051
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13632122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
9198817OtherDORAL
MAX05064NAOtherBLUE CROSS BLUE SHIELD MA
MA9721738OtherMEDICAID
MA0253049Medicaid
784074OtherUNITED CONCORDIA