Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 103094 | CA |
NPI | 1114583325 |
---|---|
Provider Name | Dr. Dipak Suri |
First Address | Lafayette, CA 94549-4251 |
Second Address | Berkeley, CA 94704-2123 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2019 |
Last Update Date | 13/07/2021 |