MEDICARE: SURESH PATTANASHETTI DMD, PA

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	:	1922125855
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURESH PATTANASHETTI DMD, PA

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	:

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	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SURESH NAGAPPA PATTANASHETTI
Credential	:	D.M.D
Telephone Number	:	410-296-5740

Provider Enumeration Date	:	03/24/2007
Last Update Date	:	09/15/2008

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