Individual
SURYA JOSEPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2787 NW DAYSHA DR, ROSEBURG, OR 97471-2980
(404) 939-5152
Mailing address
2787 NW DAYSHA DR, ROSEBURG, OR 97471-2980
(404) 939-5152
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
D11098
OR
Other
Enumeration date
08/26/2016
Last updated
11/11/2024
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