Provider Demographics
NPI:1003218421
Name:COVEN, SUSAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:COVEN
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 1:29 BARSTOW RD
Mailing Address - Street 2:105
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2222
Mailing Address - Country:US
Mailing Address - Phone:516-466-3611
Mailing Address - Fax:516-466-9398
Practice Address - Street 1:29 BARSTOW RD
Practice Address - Street 2:105
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2222
Practice Address - Country:US
Practice Address - Phone:516-466-3611
Practice Address - Fax:516-466-9398
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0364751223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics