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NPI Code Detail

MEDICARE: DR. JOSE ANTONIO SURIS D.D.S.

MEDICARE: DR. JOSE ANTONIO SURIS D.D.S.
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
11223G0001XGeneral Practice Dentistry2603PR

General Provider Information

NPI Number : 1306839386
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOSE ANTONIO SURIS D.D.S.
Provider Business Mailing Address
First Line : PO BOX 45082
Second Line :
City : SAN DIEGO
State : CA
Zip : 92145-0082
Country : US
Telephone Number : 858-437-2581
Fax Number :
Provider Business Practice Location Address
First Line : BRANCH DENTAL CLINIC MCAS MIRAMAR
Second Line : BUILDING 2495
City : SAN DIEGO
State : CA
Zip : 92145
Country : US
Telephone Number : 858-577-1825
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2005
Last Update Date : 07/08/2007

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