Provider Demographics
NPI:1013189711
Name:GRENNELL, SUSANNE T (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSANNE
Middle Name:T
Last Name:GRENNELL
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:PO BOX 153
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12510-0153
Mailing Address - Country:US
Mailing Address - Phone:845-677-0313
Mailing Address - Fax:845-677-1095
Practice Address - Street 1:2755 ROUTE 82
Practice Address - Street 2:
Practice Address - City:PLEASANT VALLEY
Practice Address - State:NY
Practice Address - Zip Code:12569-5009
Practice Address - Country:US
Practice Address - Phone:845-677-0313
Practice Address - Fax:845-677-1095
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY34188122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist