Healthcare Provider Details

I. General information

NPI: 1790618601
Provider Name (Legal Business Name): DHARSHINI VENUGOPAL SURESH
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 STANTON L YOUNG BLVD
OKLAHOMA CITY OK
73104-5018
US

IV. Provider business mailing address

103 RIDGEWOOD DR
COPPELL TX
75019-2581
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-6308
  • Fax:
Mailing address:
  • Phone: 469-570-3545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number48276
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: