Provider Demographics
NPI:1114128410
Name:M. SUZANNE AHNQUIST, D.M.D.
Entity Type:Organization
Organization Name:M. SUZANNE AHNQUIST, D.M.D.
Other - Org Name:THOROUGHBRED SMILES
Other - Org Type:Other Name
Authorized Official - Title/Position:DOCTOR-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:AHNQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-863-0880
Mailing Address - Street 1:1508 OXFORD DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9266
Mailing Address - Country:US
Mailing Address - Phone:502-863-0880
Mailing Address - Fax:502-867-7363
Practice Address - Street 1:1508 OXFORD DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9266
Practice Address - Country:US
Practice Address - Phone:502-863-0880
Practice Address - Fax:502-867-7363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty