Susmitha Marneni, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

107460 Issued in CA

Practice address

1590 Rosecrans Ave Ste N
Manhattan Beach, CA 90266-3723

Phone

(310) 643-6004

NPI assigned

Jan 6, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: susmitha.marnenidds.p1@direct.jwch.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Don Ramos Mungcal DDS a Professional Corporation

  • Dentist
  • Manhattan Beach, CA
  • NPI 1902552771
  NPD
• Walter Jefferson, D.D.S., Inc.

  • Dentist
  • Carson, CA
  • NPI 1295270734
  NPD (past)
• Cypress Dental Group and Orthodontics, PC

  • General Practice Dentistry
  • Cypress, TX
  • NPI 1225391907
  NPD (past)
• Washington Dental Corporation, PC

  • Dentist
  • Seattle, WA
  • NPI 1942793526
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1609891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730764800000",
    "number": "1730777699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1590 ROSECRANS AVE STE N",
            "city": "MANHATTAN BEACH",
            "state": "CA",
            "postal_code": "902663723",
            "telephone_number": "310-643-6004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1590 ROSECRANS AVE STE N",
            "city": "MANHATTAN BEACH",
            "state": "CA",
            "postal_code": "902663723",
            "telephone_number": "310-643-6004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARNENI",
        "first_name": "SUSMITHA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-06",
        "last_updated": "2024-11-05",
        "certification_date": "2024-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE61167850",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "36644",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "107460",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marina Pharmacy Inc.
• Mark Costopoulos DPM
• Michael Mark
• Kimberly Crystal Markley, AMFT, CTP, LMFT
• Nikole Markow
• Octavio Marquez Montoya, ATC
• Reed Maruyama, AMFT, AT
• Mary Bos, D.O., a Medical Corporation
• Maryam Bakhtiyari, D.D.S Professional Dental Corp
• Camille Garcia Marzan, DC

• Dentist in Manhattan Beach, CA
• Providers in Manhattan Beach, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.