Healthcare Provider Details

I. General information

NPI: 1134246572
Provider Name (Legal Business Name): LOKESH SURI BDS, DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 POST OFFICE SQ 9TH FLOOR
BOSTON MA
02109-3905
US

IV. Provider business mailing address

3 POST OFFICE SQ 9TH FLOOR
BOSTON MA
02109-3905
US

V. Phone/Fax

Practice location:
  • Phone: 617-426-6011
  • Fax:
Mailing address:
  • Phone: 617-426-6011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number20466
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: