Provider Demographics
NPI:1245922723
Name:PUNJABI, SURYA (DMD)
Entity type:Individual
Prefix:DR
First Name:SURYA
Middle Name:
Last Name:PUNJABI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 SW 13TH ST
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-3627
Mailing Address - Country:US
Mailing Address - Phone:425-243-7922
Mailing Address - Fax:
Practice Address - Street 1:68 SW 13TH ST
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-3627
Practice Address - Country:US
Practice Address - Phone:360-748-1833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE614448351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice