Suryamanga.D.Achyuta,DDS,Inc

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

51889 Issued in CA

Legal business name

SURYAMANGA.D.ACHYUTA,DDS,INC

Practice address

1372 N McDowell Blvd
Suite#B-1
Petaluma, CA 94954-1179

Phone

(707) 778-9993

NPI assigned

Jan 9, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Suryamanga D Achyuta

Title

Dentist

Phone

(707) 778-9993

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1199836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199836800000",
    "number": "1104001015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1372 N MCDOWELL BLVD",
            "address_2": "SUITE#B-1",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949541179",
            "telephone_number": "707-778-9993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1372 N MCDOWELL BLVD",
            "address_2": "SUITE#B-1",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949541179",
            "telephone_number": "707-778-9993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURYAMANGA.D.ACHYUTA,DDS,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-09",
        "last_updated": "2008-01-09",
        "status": "A",
        "authorized_official_last_name": "ACHYUTA",
        "authorized_official_first_name": "SURYAMANGA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "707-778-9993",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "51889",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David L Sullivan Jr.
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• General Practice Dentistry in Petaluma, CA
• Providers in Petaluma, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.