Provider Demographics
NPI:1053651778
Name:DO, SUSAN MINH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MINH
Last Name:DO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:MINH
Other - Last Name:DO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:6542 E KINGS CROWN RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-4382
Mailing Address - Country:US
Mailing Address - Phone:408-394-5846
Mailing Address - Fax:
Practice Address - Street 1:19010 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-2552
Practice Address - Country:US
Practice Address - Phone:714-968-8989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-15
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0581681223P0221X
CA1014321223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry