Provider Demographics
NPI:1124409503
Name:SUZANNE HAERI DDS
Entity Type:Organization
Organization Name:SUZANNE HAERI DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAERI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-770-2375
Mailing Address - Street 1:1100 S LA CIENEGA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2519
Mailing Address - Country:US
Mailing Address - Phone:310-657-2200
Mailing Address - Fax:310-854-0600
Practice Address - Street 1:1100 S LA CIENEGA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-2519
Practice Address - Country:US
Practice Address - Phone:310-657-2200
Practice Address - Fax:310-854-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45369122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty