Provider Demographics
NPI:1801216270
Name:SUSARLA, HARLYN KAUR (DMD, MPH)
Entity Type:Individual
Prefix:DR
First Name:HARLYN
Middle Name:KAUR
Last Name:SUSARLA
Suffix:
Gender:F
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:HARLYN
Other - Middle Name:KAUR
Other - Last Name:SIDHU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPH
Mailing Address - Street 1:111 SE EVERETT MALL WAY
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-3208
Mailing Address - Country:US
Mailing Address - Phone:425-212-1810
Mailing Address - Fax:
Practice Address - Street 1:111 SE EVERETT MALL WAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-3208
Practice Address - Country:US
Practice Address - Phone:425-212-1810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-23
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15669122300000X
WADE60654328122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist