Provider Demographics
NPI:1114067816
Name:ROHRER, SUZETTE (CDA)
Entity Type:Individual
Prefix:
First Name:SUZETTE
Middle Name:
Last Name:ROHRER
Suffix:
Gender:F
Credentials:CDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7305 OAK PARK CT
Mailing Address - Street 2:
Mailing Address - City:PFAFFTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27040-9721
Mailing Address - Country:US
Mailing Address - Phone:336-922-9297
Mailing Address - Fax:336-631-2340
Practice Address - Street 1:501 N CLEVELAND AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-4366
Practice Address - Country:US
Practice Address - Phone:336-631-2330
Practice Address - Fax:336-631-2340
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC144118126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant