Healthcare Provider Details

I. General information

NPI: 1396537403
Provider Name (Legal Business Name): SURAJ PRASAD SINHA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 09/04/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WEST COAST RD
REDWAY CA
95560
US

IV. Provider business mailing address

PO BOX 769
REDWAY CA
95560-0769
US

V. Phone/Fax

Practice location:
  • Phone: 707-923-2783
  • Fax:
Mailing address:
  • Phone: 707-923-2783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN1000852
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number112594
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: