Provider Demographics
NPI:1942220595
Name:SURESH, DHYANESH (DDS)
Entity Type:Individual
Prefix:DR
First Name:DHYANESH
Middle Name:
Last Name:SURESH
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 1:246 NE TUDOR RD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-5696
Mailing Address - Country:US
Mailing Address - Phone:816-554-1600
Mailing Address - Fax:
Practice Address - Street 1:246 NE TUDOR RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-5696
Practice Address - Country:US
Practice Address - Phone:816-554-1600
Practice Address - Fax:816-554-1798
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005017729122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist