Healthcare Provider Details

I. General information

NPI: 1528074853
Provider Name (Legal Business Name): SURENDER LAORYIA D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 12/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5727 ATLANTIC AVENUE
LONG BEACH CA
90805-4712
US

IV. Provider business mailing address

5727 ATLANTIC AVENUE
LONG BEACH CA
90805-4712
US

V. Phone/Fax

Practice location:
  • Phone: 562-432-1054
  • Fax: 562-423-8385
Mailing address:
  • Phone: 562-432-1054
  • Fax: 562-423-8385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number26456
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: