Provider Demographics
NPI:1730198938
Name:GOORAH, SOORITA DEVI (DDS)
Entity type:Individual
Prefix:
First Name:SOORITA
Middle Name:DEVI
Last Name:GOORAH
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 1:13975 CONNECTICUT AVE
Mailing Address - Street 2:SUITE # 200-201
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-2921
Mailing Address - Country:US
Mailing Address - Phone:301-460-1212
Mailing Address - Fax:301-603-0861
Practice Address - Street 1:13975 CONNECTICUT AVE
Practice Address - Street 2:SUITE # 200-201
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-2921
Practice Address - Country:US
Practice Address - Phone:301-460-1212
Practice Address - Fax:301-603-0861
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD115361223G0001X
DCDEN56811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice