Jose Antonio Suris, DMD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

626 Issued in PR

Practice address

400 Roosevelt Ave
Suite 502
San Juan, PR 00918

Phone

(787) 756-5252

NPI assigned

Aug 30, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1184734683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9022045",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009022045",
            "telephone_number": "787-724-7112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 ROOSEVELT AVE",
            "address_2": "SUITE 502",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "00918",
            "telephone_number": "787-756-5252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SURIS",
        "first_name": "JOSE",
        "middle_name": "ANTONIO",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "PR",
            "license": "626",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENCE",
            "identifier": "626",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Surgifix Inc
• Genesis Pamela Suriel Jaquez
• Marta B Surillo Gonzalez
• Michelle Ileana Surillo-Gonzalez, M.D.
• Ileana C Surillo, PSY.D
• Rosa Maria Surrilo, RNMSN
• T-Poc PR, LLC
• T&C Mental Health Home Service, Inc
• Karla M Taboas, M.S. SLP
• Rafael A. Taboas, M.D.

• Periodontics in San Juan, PR
• Providers in San Juan, PR by specialty
• Periodontics in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.