Provider Demographics
NPI:1215124458
Name:SUVARNA, AMITA KIRAN (DDS)
Entity type:Individual
Prefix:DR
First Name:AMITA
Middle Name:KIRAN
Last Name:SUVARNA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1793 ROMULUS PL
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-1770
Mailing Address - Country:US
Mailing Address - Phone:925-240-6681
Mailing Address - Fax:
Practice Address - Street 1:2225 BUCHANAN RD
Practice Address - Street 2:SUITE E
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-4209
Practice Address - Country:US
Practice Address - Phone:925-757-6117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA516561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice