Provider Demographics
NPI:1174686810
Name:WEST, SUZANNE BETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:BETH
Last Name:WEST
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-6066
Mailing Address - Country:US
Mailing Address - Phone:802-254-4770
Mailing Address - Fax:802-254-3630
Practice Address - Street 1:93 HIGH ST
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6066
Practice Address - Country:US
Practice Address - Phone:802-254-4770
Practice Address - Fax:802-254-3630
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016-0002074122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist