Provider Demographics
NPI:1992163513
Name:SRA, SUMAN DEEP (DDS)
Entity type:Individual
Prefix:DR
First Name:SUMAN DEEP
Middle Name:
Last Name:SRA
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 1:1660 HILLSDALE AVE
Mailing Address - Street 2:SUITE #120
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-3242
Mailing Address - Country:US
Mailing Address - Phone:408-267-3655
Mailing Address - Fax:
Practice Address - Street 1:1660 HILLSDALE AVE
Practice Address - Street 2:SUITE #120
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-3242
Practice Address - Country:US
Practice Address - Phone:408-267-3655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65048122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist