Provider Demographics
NPI:1053462333
Name:LUMPP, SUSANNE ELIZABETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUSANNE
Middle Name:ELIZABETH
Last Name:LUMPP
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 1:1867 PROFESSIONAL PARK CIR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4506
Mailing Address - Country:US
Mailing Address - Phone:850-942-0772
Mailing Address - Fax:
Practice Address - Street 1:1867 PROFESSIONAL PARK CIR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4506
Practice Address - Country:US
Practice Address - Phone:850-942-0772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN148871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice