Provider Demographics
NPI:1225191299
Name:SUSAN MENAPACE DELCLOS DMD MDS PA
Entity Type:Organization
Organization Name:SUSAN MENAPACE DELCLOS DMD MDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESPONSIBLE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MENAPACE
Authorized Official - Last Name:DELCLOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MDS
Authorized Official - Phone:281-261-2504
Mailing Address - Street 1:2869 DULLES AVENUE
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459
Mailing Address - Country:US
Mailing Address - Phone:281-261-2504
Mailing Address - Fax:281-499-4990
Practice Address - Street 1:2869 DULLES AVENUE
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459
Practice Address - Country:US
Practice Address - Phone:281-261-2504
Practice Address - Fax:281-499-4990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX173511223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty