Healthcare Provider Details

I. General information

NPI: 1386716447
Provider Name (Legal Business Name): DR. CALVIN BUFORD SUFFRIDGE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL POSTGRADUATE DENTAL SCHOOL 8955 WOOD ROAD
BETHESDA MD
20889-1818
US

IV. Provider business mailing address

8504 CROSSLEY PL
ALEXANDRIA VA
22308-1818
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-1831
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number3182
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: