Active NPI
Susanne Schoppert Wallengren, D.D.S.
- Pediatric Dentistry
- Lutherville, MD
National Provider Identifier
1932265055
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 12747
- Practice address
- 2324 West Joppa Rd
Suite 430
Lutherville, MD 21093 - Phone
- (410) 321-0200
- Fax
- (410) 825-1159
- NPI assigned
- Jan 1, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 3351 | NH | |
| Dentist | 122300000X | 12747 | MD | |
| Pediatric Dentistry | 1223P0221X | 12747 | MD | Primary |
| Pediatric Dentistry | 1223P0221X | DS039549 | PA | |
| Pediatric Dentistry | 1223P0221X | 3351 | NH |
Addresses
Primary practice location
2324 West Joppa Rd
Suite 430
Lutherville, MD 21093
Mailing address
2324 West Joppa Rd
Suite 430
Lutherville, MD 21093
Phone (410) 321-0200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30304152 | Medicaid | NH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12747 | MD | MD | Dentist |
| 3351 | NH | MD | Dentist |
| DS039549 | PA | MD | Pediatric Dentist |
Interoperability endpoints
- swallengren84937@direct.umm.edu
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167609600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1374710400000",
"number": "1932265055",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2324 WEST JOPPA RD",
"address_2": "SUITE 430",
"city": "LUTHERVILLE",
"state": "MD",
"postal_code": "21093",
"telephone_number": "410-321-0200",
"fax_number": "410-825-1159"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2324 WEST JOPPA RD",
"address_2": "SUITE 430",
"city": "LUTHERVILLE",
"state": "MD",
"postal_code": "21093",
"telephone_number": "410-321-0200",
"fax_number": "410-825-1159"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLENGREN",
"first_name": "SUSANNE",
"middle_name": "SCHOPPERT",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-01",
"last_updated": "2013-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NH",
"license": "3351",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MD",
"license": "12747",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "MD",
"license": "12747",
"primary": true
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "PA",
"license": "DS039549",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "NH",
"license": "3351",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30304152",
"state": "NH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lutherville, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.