Provider Demographics
NPI:1447313390
Name:PARTOVI, SUSAN (DDS)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:PARTOVI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15235 SHADY GROVE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3234
Mailing Address - Country:US
Mailing Address - Phone:301-990-0020
Mailing Address - Fax:301-990-0448
Practice Address - Street 1:15235 SHADY GROVE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3234
Practice Address - Country:US
Practice Address - Phone:301-990-0020
Practice Address - Fax:301-990-0448
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD111551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice