MEDICARE: DR. DANIEL D SURH D.M.D.

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	DS035871	PA
2	122300000X	Dentist	56562	CA

General Provider Information

NPI Number	:	1841274297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL D SURH D.M.D.

Provider Business Mailing Address
First Line	:	2477 FOREST AVE STE 170
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95928-7684
Country	:	US
Telephone Number	:	530-636-4943
Fax Number	:	530-636-4301

Provider Business Practice Location Address
First Line	:	2477 FOREST AVE STE 170
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95928-7684
Country	:	US
Telephone Number	:	530-636-4943
Fax Number	:	530-636-4301

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

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	10/28/2010

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