Provider Demographics
NPI:1942364161
Name:SUSAN PARTOVI D.D.S P.C
Entity Type:Organization
Organization Name:SUSAN PARTOVI D.D.S P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARI
Authorized Official - Middle Name:
Authorized Official - Last Name:JACHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-990-0020
Mailing Address - Street 1:15235 SHADY GROVE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3234
Mailing Address - Country:US
Mailing Address - Phone:301-990-0020
Mailing Address - Fax:301-990-0448
Practice Address - Street 1:15235 SHADY GROVE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3234
Practice Address - Country:US
Practice Address - Phone:301-990-0020
Practice Address - Fax:301-990-0448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD111551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty