Provider Demographics
NPI:1225269327
Name:SMITH, SUSAN B (RDH)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:B
Last Name:SMITH
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 N 7TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-4043
Mailing Address - Country:US
Mailing Address - Phone:919-934-3636
Mailing Address - Fax:
Practice Address - Street 1:415 N 7TH ST STE B
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4043
Practice Address - Country:US
Practice Address - Phone:919-934-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1254124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist