Provider Demographics
NPI:1043344328
Name:OLCOTT, SUSAN LOUISE (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LOUISE
Last Name:OLCOTT
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 1:520 S. ALLEN RD SUITE 4
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:NC
Mailing Address - Zip Code:28731
Mailing Address - Country:US
Mailing Address - Phone:828-693-0911
Mailing Address - Fax:828-693-9529
Practice Address - Street 1:520 S. ALLEN RD SUITE 4
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:NC
Practice Address - Zip Code:28731
Practice Address - Country:US
Practice Address - Phone:828-693-0911
Practice Address - Fax:828-693-9529
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6855122300000X
TX244781223G0001X
NC6855NC1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist