Surya Manga Devi Achyuta, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

51889 Issued in CA

Practice address

1372 N McDowell Blvd Ste B1
Petaluma, CA 94954-7101

Phone

(707) 778-9993

Fax

(707) 200-2146

NPI assigned

Oct 5, 2006

Last updated

Oct 4, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

• Suryamanga.D.Achyuta,DDS,Inc

  • General Practice Dentistry
  • Petaluma, CA
  • NPI 1104001015
  Authorized official Same address or phone

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728000000000",
    "number": "1598851693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1372 N MCDOWELL BLVD STE B1",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949547101",
            "telephone_number": "707-778-9993",
            "fax_number": "707-200-2146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1372 N MCDOWELL BLVD STE B1",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949547101",
            "telephone_number": "707-778-9993",
            "fax_number": "707-200-2146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ACHYUTA",
        "first_name": "SURYA MANGA",
        "middle_name": "DEVI",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-05",
        "last_updated": "2024-10-04",
        "certification_date": "2024-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "51889",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blythe Abbey, L.AC
• Robert Ray Abbott-Florez, M.A.
• Marina Louise Abbott
• Sherwin Abdoli, MD
• Tino Orlando Abon Jr., DC
• Alexandria Adames
• Sakiyia Yolanda Adams-Kinsey
• Amy Adams, M.D.
• Jodi Lynn Adams, M.D.
• Kathleen Adams

• 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 Oct 4, 2024; 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.