Provider Demographics
NPI:1932645736
Name:PANSURIYA, DHARMENDRA (DMD)
Entity Type:Individual
Prefix:DR
First Name:DHARMENDRA
Middle Name:
Last Name:PANSURIYA
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 1:8369 WINGATE DR UNIT 2123
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-5429
Mailing Address - Country:US
Mailing Address - Phone:941-524-9190
Mailing Address - Fax:
Practice Address - Street 1:5641 CLARK RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-3216
Practice Address - Country:US
Practice Address - Phone:941-524-9190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN220181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice