Provider Demographics
NPI:1033134945
Name:HAN, SUSAN (DMD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:HAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 BEACON ST
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-3885
Mailing Address - Country:US
Mailing Address - Phone:617-277-4100
Mailing Address - Fax:
Practice Address - Street 1:1180 BEACON ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3885
Practice Address - Country:US
Practice Address - Phone:617-277-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2017-05-17
Deactivation Date:2017-01-24
Deactivation Code:
Reactivation Date:2017-05-17
Provider Licenses
StateLicense IDTaxonomies
MADN1855274122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist