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Individual

SUSAN RA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DDS

Contact information

Practice address
156 RITCHIE HWY, SEVERNA PARK, MD 21146-1117
(410) 647-1800
Mailing address
2418 HUDSON ST, BALTIMORE, MD 21224-3637
(410) 925-6257

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
13346
MD

Other

Enumeration date
05/22/2007
Last updated
07/08/2007
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