Provider Demographics
NPI:1063515617
Name:DHAKAR, SURYA PRAKASH (DDS)
Entity type:Individual
Prefix:DR
First Name:SURYA
Middle Name:PRAKASH
Last Name:DHAKAR
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 1:4440 SPRINGFIELD RD
Mailing Address - Street 2:STE 101
Mailing Address - City:GUN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060
Mailing Address - Country:US
Mailing Address - Phone:804-217-9820
Mailing Address - Fax:804-217-9822
Practice Address - Street 1:4440 SPRINGFIELD RD
Practice Address - Street 2:STE 101
Practice Address - City:GUN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060
Practice Address - Country:US
Practice Address - Phone:804-217-9820
Practice Address - Fax:804-217-9822
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410078122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA14534OtherDORAL DENTAL
VA817248OtherUNITED CONCORDIA