MEDICARE: PATRICIA ROSE SUING 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	D11096	OR

General Provider Information

NPI Number	:	1154975076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA ROSE SUING DMD

Provider Business Mailing Address
First Line	:	1420 E MCANDREWS RD
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97504-6108
Country	:	US
Telephone Number	:	541-779-2634
Fax Number	:

Provider Business Practice Location Address
First Line	:	1420 E MCANDREWS RD
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97504-6108
Country	:	US
Telephone Number	:	541-779-2634
Fax Number	:

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

Provider Enumeration Date	:	07/29/2019
Last Update Date	:	07/29/2019

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Directions to “ PATRICIA ROSE SUING DMD” Practice Location

Language	Start Address	Practice Location

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