Provider Demographics
NPI:1730777699
Name:MARNENI, SUSMITHA (DDS)
Entity type:Individual
Prefix:DR
First Name:SUSMITHA
Middle Name:
Last Name:MARNENI
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 1:1590 ROSECRANS AVE STE N
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-3723
Mailing Address - Country:US
Mailing Address - Phone:310-643-6004
Mailing Address - Fax:
Practice Address - Street 1:1590 ROSECRANS AVE STE N
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-3723
Practice Address - Country:US
Practice Address - Phone:310-643-6004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61167850122300000X
TX366441223G0001X
CA107460122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice