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General NPI Number Information
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NPI Number | 1588816185
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Entity Type | Organization
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Legal Business Name | SURI & TANEJA PC
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Dates
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Enumeration Date | 10/15/2008
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Last Update Date | 10/15/2008
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Provider Practice Location Address
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Address Line | 241 W CANTON ST UNIT 2
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City | BOSTON
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State | MA
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Zip | 02116-5849
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Country | US
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Telephone | 617-504-3134
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Fax |
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Provider Business Mailing Address
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Address Line | 241 W CANTON ST APT. 2
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City | BOSTON
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State | MA
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Zip | 02116-5849
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LOKESH SURI
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Credential | DMD, MS
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Telephone | 617-504-3134
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 20466
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License Number State | MA
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