Surgical Center for Dental Professionals of NC LLC

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

Legal business name

SURGICAL CENTER FOR DENTAL PROFESSIONALS OF NC LLC

Practice address

2620 New Bern Ave
Raleigh, NC 27610-1821

Phone

(919) 526-1000

NPI assigned

Feb 23, 2019

Organization subpart

Yes

Parent organization

SURGICAL CENTER FOR DENTAL PROFESSIONALS OF NC LLCAs reported in NPPES

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

Authorized official

Name

Mr. Devin Larsen

Title

Ceo

Phone

(208) 340-1840

Specialties & licenses 3

Addresses

Other names 1

• SCDP Anesthesia Professionals Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Surgical Center for Dental Professionals of NC LLC

  • Ambulatory Surgical Clinic/Center
  • Raleigh, NC
  • NPI 1932634029

  1153662002

  Same PAC ID

Part of

Surgical Center for Dental Professionals of NC LLC

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Surgical Center for Dental Professionals of NC LLC

  • Ambulatory Surgical Clinic/Center
  • Raleigh, NC
  • NPI 1932634029
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Rachael D'Souza

  • Dentist
  • Pittsburgh, PA
  • NPI 1952709818

  NC

  Medicare reassignment

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

{
    "created_epoch": "1550880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717027200000",
    "number": "1821555020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2620 NEW BERN AVE",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276101821",
            "telephone_number": "919-526-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2620 NEW BERN AVE",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276101821",
            "telephone_number": "919-526-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGICAL CENTER FOR DENTAL PROFESSIONALS OF NC LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SURGICAL CENTER FOR DENTAL PROFESSIONALS OF NC LLC",
        "enumeration_date": "2019-02-23",
        "last_updated": "2024-05-30",
        "certification_date": "2024-05-30",
        "status": "A",
        "authorized_official_last_name": "LARSEN",
        "authorized_official_first_name": "DEVIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-340-1840",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiologist Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SCDP Anesthesia Professionals",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Supreme Youth Development Center
• Kawanjit Surapur, MD
• Rajini Surendra, MD
• Sruthi Suresh
• Suresteps Inc
• Surgical Center for Dental Professionals of NC LLC
• Amanda Marie Surguine, PTA
• Dnadia Myaja Surles, MSW, LCSWA
• Emma Joelle Surles, RD
• Morgan Faith Surles, PHARMD

• Anesthesiology Physician in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Anesthesiology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.