Individual
DIVYA SURESH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
PLYMOUTH MEETING FAMILY DENTAL, 350 E GERMANTOWN PIKE, EAST NORRITON, PA 19401
(610) 828-4100
Mailing address
415 WALLACE ST APT 2E, PHILADELPHIA, PA 19123-2298
(757) 375-6116
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS043996
PA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/13/2020
Last updated
04/12/2023
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