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Individual

MISS SUSEE PRIYANKA RAVURI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
BDS, MPA, MSD

Contact information

Practice address
1002 N MERIDIAN STE A104, PUYALLUP, WA 98371-4409
(619) 300-9832
Mailing address
1002 N MERIDIAN STE A104, PUYALLUP, WA 98371-4409
(619) 300-9832

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
0401415871
VA
1223G0001X
General Practice Dentistry
Primary
DE60729800
WA
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
05/23/2016
Last updated
02/11/2020
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