Provider Demographics
NPI:1053504068
Name:SURASKY, MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:
Last Name:SURASKY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 KENILWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20781
Mailing Address - Country:US
Mailing Address - Phone:301-277-1214
Mailing Address - Fax:
Practice Address - Street 1:5310 KENILWORTH AVE
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20781
Practice Address - Country:US
Practice Address - Phone:301-277-1214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD86771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice