Healthcare Provider Details

I. General information

NPI: 1598670309
Provider Name (Legal Business Name): URVA SURYAWALA DDS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18189 VAN BUREN BLVD SUITE 103
RIVERSIDE CA
92508
US

IV. Provider business mailing address

PO BOX 129
COLTON CA
92324-0129
US

V. Phone/Fax

Practice location:
  • Phone: 323-975-2725
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: URVA SURYAWALA
Title or Position: OWNER/ PRESIDENT
Credential: DDS, MSD
Phone: 323-975-2725