Mary Jane Suppasansathorn, DDS

NPI #1013076934 in Raytown, Missouri

Provider Information

NPI Number: 1013076934
Entity Type: Individual
Name: Mary Jane Suppasansathorn, DDS
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dentist
Credential: DDS
Enumeration Date: Dec 6, 2006
Last Updated: Jul 8, 2007

Practice Location

Address: 7316 RAYTOWN ROAD
City: Raytown
State: Missouri
ZIP Code: 64133
Phone: (816) 353-0140

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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