Provider Demographics
NPI:1023325958
Name:SUH, JEANNETTE E (DMD)
Entity type:Individual
Prefix:DR
First Name:JEANNETTE
Middle Name:E
Last Name:SUH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ARCADE UNIT 198747
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37219-1994
Mailing Address - Country:US
Mailing Address - Phone:615-750-0343
Mailing Address - Fax:615-986-1705
Practice Address - Street 1:30 AUDREY LN
Practice Address - Street 2:SUITE A
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-1301
Practice Address - Country:US
Practice Address - Phone:301-567-5437
Practice Address - Fax:301-567-5456
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14582122300000X, 1223G0001X
DCDEN10010641223G0001X
VA04014129541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1023325958Medicaid
VA1023325958Medicaid
DC043275300Medicaid