Active NPI
Anthony Ray Surratt, DMD
- Dentist
- Aberdeen, WA
National Provider Identifier
1922623529
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 61061366
- Practice address
- 505 N Broadway St
Aberdeen, WA 98520-3924 - Phone
- (360) 532-3888
- NPI assigned
- Jun 10, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 61061366 | WA | Primary |
Addresses
Primary practice location
505 N Broadway St
Aberdeen, WA 98520-3924
Mailing address
706 Granada Rd
Aberdeen, WA 98520-7454
Phone (360) 532-3888
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Apr 14, 2022 through Apr 14, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61061366 | WA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1591747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1630627200000",
"number": "1922623529",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "706 GRANADA RD",
"city": "ABERDEEN",
"state": "WA",
"postal_code": "985207454",
"telephone_number": "360-532-3888"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "505 N BROADWAY ST",
"city": "ABERDEEN",
"state": "WA",
"postal_code": "985203924",
"telephone_number": "360-532-3888"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SURRATT",
"first_name": "ANTHONY",
"middle_name": "RAY",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-06-10",
"last_updated": "2021-09-03",
"certification_date": "2021-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "61061366",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Aberdeen, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2021; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.