Healthcare Provider Details

I. General information

NPI: 1578225629
Provider Name (Legal Business Name): SURBHI ABROL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LACKAWANNA AVE FL 1
SCRANTON PA
18503-2001
US

IV. Provider business mailing address

529 BOGART PL APT 301
SCRANTON PA
18503-2002
US

V. Phone/Fax

Practice location:
  • Phone: 570-343-4472
  • Fax:
Mailing address:
  • Phone: 215-200-7184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS043405
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: