Provider Demographics
NPI:1780744904
Name:DURGAPERSAD, SUSAN G (DDS)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:G
Last Name:DURGAPERSAD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8438 FM 1960 BYPASS WEST
Mailing Address - Street 2:SUITE A
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338
Mailing Address - Country:US
Mailing Address - Phone:281-540-7724
Mailing Address - Fax:281-540-7728
Practice Address - Street 1:8438 FM 1960 BYPASS WEST
Practice Address - Street 2:SUITE A
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338
Practice Address - Country:US
Practice Address - Phone:281-540-7724
Practice Address - Fax:281-540-7728
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21732122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist