Provider Demographics
NPI:1023388188
Name:KNIGHT, SUSANNE ROSE (RHD)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:ROSE
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:RHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 OSTERMANN DRIVE
Mailing Address - Street 2:CESA #11 RURAL HEALTH DENTAL CLINIC
Mailing Address - City:TURTLE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54889-0000
Mailing Address - Country:US
Mailing Address - Phone:715-986-2020
Mailing Address - Fax:715-986-2041
Practice Address - Street 1:212 MAPLE STREET
Practice Address - Street 2:
Practice Address - City:TURTLE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54889
Practice Address - Country:US
Practice Address - Phone:715-986-2599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5072-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist