Provider Demographics
NPI:1922125855
Name:SURESH PATTANASHETTI DMD, PA
Entity Type:Organization
Organization Name:SURESH PATTANASHETTI DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:NAGAPPA
Authorized Official - Last Name:PATTANASHETTI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:410-296-5740
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-24
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12384122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty