Provider Demographics
NPI:1821832734
Name:SURUJNARAIN, DUSHALA (DDS)
Entity type:Individual
Prefix:DR
First Name:DUSHALA
Middle Name:
Last Name:SURUJNARAIN
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 1:2761 SOUTHLAND ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34772-7859
Mailing Address - Country:US
Mailing Address - Phone:917-804-7904
Mailing Address - Fax:
Practice Address - Street 1:11007 ARCADE PL
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-4908
Practice Address - Country:US
Practice Address - Phone:941-213-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2025-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT141161223G0001X
FL301891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice