Provider Demographics
NPI:1154325041
Name:GRABER, SUSAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:GRABER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 PALMER CT
Mailing Address - Street 2:
Mailing Address - City:RIVERWOODS
Mailing Address - State:IL
Mailing Address - Zip Code:60015-3836
Mailing Address - Country:US
Mailing Address - Phone:847-940-0949
Mailing Address - Fax:
Practice Address - Street 1:2440 RAVINE WAY
Practice Address - Street 2:STE 400
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-7647
Practice Address - Country:US
Practice Address - Phone:847-729-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19164041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice