Provider Demographics
NPI:1326181181
Name:SURTI, BHUPENDRA D (DDS)
Entity type:Individual
Prefix:DR
First Name:BHUPENDRA
Middle Name:D
Last Name:SURTI
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 1:363 MANHATTAN ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10307-1808
Mailing Address - Country:US
Mailing Address - Phone:718-356-2093
Mailing Address - Fax:718-356-2093
Practice Address - Street 1:8111 45TH AVE
Practice Address - Street 2:SUITE NO 1J
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11373-3553
Practice Address - Country:US
Practice Address - Phone:718-424-5757
Practice Address - Fax:718-424-5757
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00298339Medicaid