Healthcare Provider Details

I. General information

NPI: 1083815351
Provider Name (Legal Business Name): AJAY SURI DDS MS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 RAHLING CIR
LITTLE ROCK AR
72223
US

IV. Provider business mailing address

PO BOX 241534
LITTLE ROCK AR
72223-0010
US

V. Phone/Fax

Practice location:
  • Phone: 501-821-5859
  • Fax: 501-588-3455
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. AJAY SURI
Title or Position: PRESIDENT
Credential: DDS, MS
Phone: 501-944-6671