Provider Demographics
NPI:1215006382
Name:ERLEMEIER, SUSAN E (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:E
Last Name:ERLEMEIER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:BAUM
Other - Last Name:ERLEMEIER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1297 SHREVEPORT BARKSDALE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105
Mailing Address - Country:US
Mailing Address - Phone:318-865-8725
Mailing Address - Fax:318-869-4725
Practice Address - Street 1:506 HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:STERLINGTON
Practice Address - State:LA
Practice Address - Zip Code:71280-3004
Practice Address - Country:US
Practice Address - Phone:318-598-5040
Practice Address - Fax:318-869-4725
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA43241223G0001X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1843245Medicaid
LA31778OtherLA BOARD OF PHARMACY
LA31778OtherLA BOARD OF PHARMACY