MEDICARE: SOORITA DEVI GOORAH DDS

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	1223G0001X	General Practice Dentistry	11536	MD
2	1223G0001X	General Practice Dentistry	DEN5681	DC

General Provider Information

NPI Number	:	1730198938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOORITA DEVI GOORAH DDS

Provider Business Mailing Address
First Line	:	13975 CONNECTICUT AVE
Second Line	:	SUITE # 200-201
City	:	SILVER SPRING
State	:	MD
Zip	:	20906-2921
Country	:	US
Telephone Number	:	301-460-1212
Fax Number	:	301-603-0861

Provider Business Practice Location Address
First Line	:	13975 CONNECTICUT AVE
Second Line	:	SUITE # 200-201
City	:	SILVER SPRING
State	:	MD
Zip	:	20906-2921
Country	:	US
Telephone Number	:	301-460-1212
Fax Number	:	301-603-0861

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	07/08/2007

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