Provider Demographics
NPI:1942990528
Name:SURYAWALA, URVA (DDS)
Entity Type:Individual
Prefix:
First Name:URVA
Middle Name:
Last Name:SURYAWALA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11834 GREENBRIER LN
Mailing Address - Street 2:
Mailing Address - City:GRAND TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:92313-8341
Mailing Address - Country:US
Mailing Address - Phone:323-975-2725
Mailing Address - Fax:
Practice Address - Street 1:11834 GREENBRIER LN
Practice Address - Street 2:
Practice Address - City:GRAND TERRACE
Practice Address - State:CA
Practice Address - Zip Code:92313-8341
Practice Address - Country:US
Practice Address - Phone:323-975-2725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107035122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist