Provider Demographics
NPI:1922623529
Name:SURRATT, ANTHONY RAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:RAY
Last Name:SURRATT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 GRANADA RD
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-7454
Mailing Address - Country:US
Mailing Address - Phone:360-532-3888
Mailing Address - Fax:
Practice Address - Street 1:505 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-3924
Practice Address - Country:US
Practice Address - Phone:360-532-3888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61061366122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist