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Individual
SRINIVAS M SUSARLA
Active
Individual
SRINIVAS M SUSARLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, DMD
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DF60668028
WA
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
MD60628000
WA
Other
Enumeration date
08/05/2007
Last updated
08/28/2017
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