Provider Demographics
NPI:1316213192
Name:SUBRAMANIAN, DEEPA (DDS)
Entity type:Individual
Prefix:
First Name:DEEPA
Middle Name:
Last Name:SUBRAMANIAN
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 1:7651 MATAPEAKE BUSINESS DRIVE SUITE 106
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-3039
Mailing Address - Country:US
Mailing Address - Phone:301-542-9938
Mailing Address - Fax:301-782-2940
Practice Address - Street 1:7651 MATAPEAKE BUSINESS DRIVE SUITE 106
Practice Address - Street 2:
Practice Address - City:BRANDYWINE
Practice Address - State:MD
Practice Address - Zip Code:20613-3039
Practice Address - Country:US
Practice Address - Phone:301-542-9938
Practice Address - Fax:301-782-2940
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14882122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist