Provider Demographics
NPI:1124045844
Name:PATTANASHETTI, SURESH NAGAPPA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SURESH
Middle Name:NAGAPPA
Last Name:PATTANASHETTI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8601 LASALLE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-2004
Mailing Address - Country:US
Mailing Address - Phone:410-296-5740
Mailing Address - Fax:410-296-5743
Practice Address - Street 1:8601 LASALLE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-2004
Practice Address - Country:US
Practice Address - Phone:410-296-5740
Practice Address - Fax:410-296-5743
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12384122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist