Healthcare Provider Details

I. General information

NPI: 1124714134
Provider Name (Legal Business Name): PRIYANKA SURI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 LYNNWAY
LYNN MA
01901-1811
US

IV. Provider business mailing address

3064 PINON CANYON LN
RICHARDSON TX
75082-3746
US

V. Phone/Fax

Practice location:
  • Phone: 781-599-5437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN10001595
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: