Provider Demographics
NPI:1023526134
Name:SUMAN SRA DDS INC
Entity type:Organization
Organization Name:SUMAN SRA DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-923-8500
Mailing Address - Street 1:750 N CAPITOL AVE, SUITE C-1,
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95133
Mailing Address - Country:US
Mailing Address - Phone:408-923-8500
Mailing Address - Fax:408-923-0448
Practice Address - Street 1:750 N CAPITOL AVE, SUITE C-1,
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95133
Practice Address - Country:US
Practice Address - Phone:408-923-8500
Practice Address - Fax:408-923-0448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA650481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty