Provider Demographics
NPI:1912607326
Name:AQUIT, SURISADAI (DDS)
Entity Type:Individual
Prefix:
First Name:SURISADAI
Middle Name:
Last Name:AQUIT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SURI
Other - Middle Name:
Other - Last Name:AQUIT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2103 FREDERICK DOUGLASS BLVD APT 3D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-2750
Mailing Address - Country:US
Mailing Address - Phone:617-447-5702
Mailing Address - Fax:
Practice Address - Street 1:8110 BIRMINGHAM WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2758
Practice Address - Country:US
Practice Address - Phone:619-662-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program