Healthcare Provider Details

I. General information

NPI: 1205463742
Provider Name (Legal Business Name): SONIA SURI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 FAIRFAX CORNER AVE E STE 235
FAIRFAX VA
22030-8623
US

IV. Provider business mailing address

4211 FAIRFAX CORNER AVE E STE 235
FAIRFAX VA
22030-8623
US

V. Phone/Fax

Practice location:
  • Phone: 703-449-8888
  • Fax:
Mailing address:
  • Phone: 703-449-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0438000538
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: