Individual provider Active NPI

Suren Paravyan, DMD, MD, MSD

  • Endodontics
  • Fayetteville, NC
National Provider Identifier
1154554178
Registry record updated Mar 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
9131 Issued in NC
Practice address
572 Sandhurst Dr.
Fayetteville, NC 28304-4426
Phone
(910) 485-3636
Fax
(910) 222-9401
NPI assigned
Aug 25, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 9131 NC
Endodontics 1223E0200X 9131 NC Primary
Dentist 122300000X 0442000101 VA

Addresses

Primary practice location

572 Sandhurst Dr.
Fayetteville, NC 28304-4426

Mailing address

572 Sandhurst Dr.
Fayetteville, NC 28304-4426
Phone (910) 485-3636

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
9131NCMDMental Health Counselor
0442000101VAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Suren Paravyan, DMD, MD, MSD, PA Endodontics CurrentSince Apr 3, 2022 Accepting new patients

Locations

201 S McPherson Church Rd
Ste 102
Fayetteville, NC 28303
Phone (910) 438-9400

572 Sandhurst Dr
Fayetteville, NC 28304
Phone (910) 485-3636

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1251158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648425600000",
    "number": "1154554178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "572 SANDHURST DR.",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044426",
            "telephone_number": "910-485-3636",
            "fax_number": "910-222-9401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "572 SANDHURST DR.",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044426",
            "telephone_number": "910-485-3636",
            "fax_number": "910-222-9401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARAVYAN",
        "first_name": "SUREN",
        "credential": "DMD, MD, MSD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-25",
        "last_updated": "2022-03-28",
        "certification_date": "2022-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NC",
            "license": "9131",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "NC",
            "license": "9131",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0442000101",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2022; 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.