Healthcare Provider Details

I. General information

NPI: 1194911289
Provider Name (Legal Business Name): SUREN CHELIAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 12/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 RIVERSIDE ST UNIT D
NASHUA NH
03062-1396
US

IV. Provider business mailing address

29 RIVERSIDE ST UNIT D
NASHUA NH
03062-1396
US

V. Phone/Fax

Practice location:
  • Phone: 603-882-6100
  • Fax:
Mailing address:
  • Phone: 603-882-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number21189
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number03625
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: