MEDICARE: JAMES SURDILLA DDS

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	46529	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D46529	OTHER	CA	DENTI-CAL

General Provider Information

NPI Number	:	1366636524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES SURDILLA DDS

Provider Business Mailing Address
First Line	:	10929 SOUTH ST STE 114B
Second Line	:
City	:	CERRITOS
State	:	CA
Zip	:	90703-5365
Country	:	US
Telephone Number	:	562-924-2711
Fax Number	:	562-924-0288

Provider Business Practice Location Address
First Line	:	3557 E SOUTH ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-4519
Country	:	US
Telephone Number	:	562-633-8848
Fax Number	:	562-633-6303

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES SURDILLA
Credential	:	DDS
Telephone Number	:	562-633-8848

Provider Enumeration Date	:	08/30/2007
Last Update Date	:	10/09/2015

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