1427165737 NPI number — SUMAN VIDYARTHI, DDS AND NANDITHA J. VIVEKANANTHAN, DDS, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427165737 NPI number — SUMAN VIDYARTHI, DDS AND NANDITHA J. VIVEKANANTHAN, DDS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUMAN VIDYARTHI, DDS AND NANDITHA J. VIVEKANANTHAN, DDS, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427165737
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5832 FAYETTEVILLE RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27713-6290
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-544-7777
Provider Business Mailing Address Fax Number:
919-544-7733

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5832 FAYETTEVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27713-6290
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-544-7777
Provider Business Practice Location Address Fax Number:
919-544-7733
Provider Enumeration Date:
08/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VIDYARTHI
Authorized Official First Name:
SUMAN
Authorized Official Middle Name:
KUMAR
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
919-544-7777

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  7188 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 7817 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5901638 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 89064XH , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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