Provider Demographics
NPI:1427165737
Name:SUMAN VIDYARTHI, DDS AND NANDITHA J. VIVEKANANTHAN, DDS, PA
Entity type:Organization
Organization Name:SUMAN VIDYARTHI, DDS AND NANDITHA J. VIVEKANANTHAN, DDS, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUMAN
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:VIDYARTHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-544-7777
Mailing Address - Street 1:5832 FAYETTEVILLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6290
Mailing Address - Country:US
Mailing Address - Phone:919-544-7777
Mailing Address - Fax:919-544-7733
Practice Address - Street 1:5832 FAYETTEVILLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6290
Practice Address - Country:US
Practice Address - Phone:919-544-7777
Practice Address - Fax:919-544-7733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC78171223G0001X
NC71881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901638Medicaid
NC89064XHMedicaid