Provider Demographics
NPI:1154554178
Name:PARAVYAN, SUREN (DMD, MD, MSD)
Entity type:Individual
Prefix:
First Name:SUREN
Middle Name:
Last Name:PARAVYAN
Suffix:
Gender:M
Credentials:DMD, MD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:572 SANDHURST DR.
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4426
Mailing Address - Country:US
Mailing Address - Phone:910-485-3636
Mailing Address - Fax:910-222-9401
Practice Address - Street 1:572 SANDHURST DR.
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4426
Practice Address - Country:US
Practice Address - Phone:910-485-3636
Practice Address - Fax:910-222-9401
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9131122300000X, 1223E0200X
VA0442000101122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist