MEDICARE: HIRAM SURIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	1321	PR

General Provider Information

NPI Number	:	1265595490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HIRAM SURIS

Provider Business Mailing Address
First Line	:	1379 PASEO DE DON JUAN APT. 2B,SAN JUAN P.R.
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00907
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 AVE LAGUNA # 205
Second Line	:
City	:	CAROLINA
State	:	PR
Zip	:	00979-6400
Country	:	US
Telephone Number	:	787-791-0992
Fax Number	:	787-791-0992

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	07/08/2007

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Directions to “ HIRAM SURIS ” Practice Location

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