Dr. Susanne Schoppert Wallengren, D.D.S.
Dentist, Pediatric Dentistry in Lutherville, MD. Individual provider (NPI-1).
NPI number1932265055
StatusActive
Last updated in NPPESJul 25, 2013
Details
- NPI
- 1932265055
- Entity type
- Individual (NPI-1)
- Name
- Dr. Susanne Schoppert Wallengren
- Credential
- D.D.S.
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jan 1, 2007
- Last updated
- Jul 25, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223P0221X | Dentist, Pediatric Dentistry | 12747 | MD | Yes |
| 122300000X | Dentist | 3351 | NH | |
| 122300000X | Dentist | 12747 | MD | |
| 1223P0221X | Dentist, Pediatric Dentistry | ds039549 | PA | |
| 1223P0221X | Dentist, Pediatric Dentistry | 3351 | NH |
Practice location
2324 West Joppa RdSuite 430
Lutherville, MD 21093
Phone 410-321-0200 · Fax 410-825-1159
Mailing address
2324 West Joppa RdSuite 430
Lutherville, MD 21093
Phone 410-321-0200 · Fax 410-825-1159
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