Provider Demographics
NPI:1881744753
Name:VIDYARTHI, SUMAN KUMAR (DDS)
Entity type:Individual
Prefix:DR
First Name:SUMAN
Middle Name:KUMAR
Last Name:VIDYARTHI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5832 FAYETTEVILLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6290
Mailing Address - Country:US
Mailing Address - Phone:919-544-7777
Mailing Address - Fax:919-544-7733
Practice Address - Street 1:5832 FAYETTEVILLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6290
Practice Address - Country:US
Practice Address - Phone:919-544-7777
Practice Address - Fax:919-544-7733
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC78171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901638Medicaid