Provider Demographics
NPI:1649809450
Name:DAS, SURINA
Entity type:Individual
Prefix:DR
First Name:SURINA
Middle Name:
Last Name:DAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12520 PROSPERITY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1664
Mailing Address - Country:US
Mailing Address - Phone:301-989-8994
Mailing Address - Fax:
Practice Address - Street 1:12520 PROSPERITY DR STE 300
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1664
Practice Address - Country:US
Practice Address - Phone:301-989-8994
Practice Address - Fax:410-651-4256
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD174281223P0221X
MDLL866390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid