Provider Demographics
NPI:1659323269
Name:SUR, DANIEL (DDS)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:SUR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 NILES ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93305-4806
Mailing Address - Country:US
Mailing Address - Phone:661-326-0766
Mailing Address - Fax:661-326-6482
Practice Address - Street 1:1518 NILES ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93305-4806
Practice Address - Country:US
Practice Address - Phone:661-326-0766
Practice Address - Fax:661-326-6482
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51139122300000X
CA51089122300000X
CA52632122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist