Provider Demographics
NPI:1649437062
Name:SUR, ANTHONY KY (DDS)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:KY
Last Name:SUR
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 1:630 KILAUEA AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4243
Mailing Address - Country:US
Mailing Address - Phone:808-969-6665
Mailing Address - Fax:808-969-6665
Practice Address - Street 1:630 KILAUEA AVE STE 103
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4243
Practice Address - Country:US
Practice Address - Phone:808-969-6665
Practice Address - Fax:808-969-6665
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-13061223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics