Provider Demographics
NPI:1962889006
Name:SRIKUREJA, SUTHEEP DAVE (DDS)
Entity type:Individual
Prefix:
First Name:SUTHEEP
Middle Name:DAVE
Last Name:SRIKUREJA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:DAVE
Other - Middle Name:
Other - Last Name:SRIKUREJA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:25802 HUDSON CT
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3905
Mailing Address - Country:US
Mailing Address - Phone:707-738-9819
Mailing Address - Fax:
Practice Address - Street 1:8660 CENTRAL AVE STE A
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-1692
Practice Address - Country:US
Practice Address - Phone:909-920-0696
Practice Address - Fax:909-920-0517
Is Sole Proprietor?:No
Enumeration Date:2015-04-28
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA644061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice