Provider Demographics
NPI:1003010190
Name:DRAGOO, SUSAN G (RDHAP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:G
Last Name:DRAGOO
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28833 GUNTER RD
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-2039
Mailing Address - Country:US
Mailing Address - Phone:310-847-9293
Mailing Address - Fax:310-831-0575
Practice Address - Street 1:28833 GUNTER RD
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-2039
Practice Address - Country:US
Practice Address - Phone:310-847-9293
Practice Address - Fax:310-831-0575
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA180124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist