MEDICARE: MRS. SURENDER LAORYIA 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
1	122300000X	Dentist	26456	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	507040	OTHER	CA	DENTI CAL

General Provider Information

NPI Number	:	1528074853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SURENDER LAORYIA D.D.S.

Provider Business Mailing Address
First Line	:	5727 ATLANTIC AVENUE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-4712
Country	:	US
Telephone Number	:	562-432-1054
Fax Number	:	562-423-8385

Provider Business Practice Location Address
First Line	:	5727 ATLANTIC AVENUE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-4712
Country	:	US
Telephone Number	:	562-432-1054
Fax Number	:	562-423-8385

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	12/08/2008

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