Provider Demographics
NPI:1386926830
Name:SURGER, EDWARD FRED (DDS)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:FRED
Last Name:SURGER
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 1:1401 AVOCADO AVE
Mailing Address - Street 2:SUITE 507
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7720
Mailing Address - Country:US
Mailing Address - Phone:949-640-0501
Mailing Address - Fax:949-640-0826
Practice Address - Street 1:1401 AVOCADO AVE
Practice Address - Street 2:SUITE 507
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7720
Practice Address - Country:US
Practice Address - Phone:949-640-0501
Practice Address - Fax:949-640-0826
Is Sole Proprietor?:No
Enumeration Date:2011-09-11
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA586181223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry