Provider Demographics
NPI:1558536672
Name:SUSANA RAYGADA D.M.D., P.C.
Entity type:Organization
Organization Name:SUSANA RAYGADA D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYGADA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:703-323-1400
Mailing Address - Street 1:5211 LYNGATE CT
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1671
Mailing Address - Country:US
Mailing Address - Phone:703-323-1400
Mailing Address - Fax:703-426-0415
Practice Address - Street 1:5211 LYNGATE CT
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1671
Practice Address - Country:US
Practice Address - Phone:703-323-1400
Practice Address - Fax:703-426-0415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty