MEDICARE: DR. SURESH NAGAPPA PATTANASHETTI DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	12384	MD

General Provider Information

NPI Number	:	1124045844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SURESH NAGAPPA PATTANASHETTI DMD

Provider Business Mailing Address
First Line	:	8601 LASALLE RD
Second Line	:	SUITE 200
City	:	TOWSON
State	:	MD
Zip	:	21286-2004
Country	:	US
Telephone Number	:	410-296-5740
Fax Number	:	410-296-5743

Provider Business Practice Location Address
First Line	:	8601 LASALLE RD
Second Line	:	SUITE 200
City	:	TOWSON
State	:	MD
Zip	:	21286-2004
Country	:	US
Telephone Number	:	410-296-5740
Fax Number	:	410-296-5743

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	07/08/2007

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