Provider Demographics
NPI:1053056325
Name:KEEFE, SUSAN HUANG
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:HUANG
Last Name:KEEFE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PENGQIAN
Other - Middle Name:
Other - Last Name:HUANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8010 SUNDANCE CIR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-5919
Mailing Address - Country:US
Mailing Address - Phone:718-839-3909
Mailing Address - Fax:
Practice Address - Street 1:120 DENTAL CIR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-5021
Practice Address - Country:US
Practice Address - Phone:919-537-3944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12853122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist