Provider Demographics
NPI:1225311699
Name:DISENSO, SUSAN (D,D,S,)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:DISENSO
Suffix:
Gender:F
Credentials:D,D,S,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 HOSPITAL OVAL W
Mailing Address - Street 2:DENTAL DEPT/CEDARWOOD HALL 2ND FLOOR
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1559
Mailing Address - Country:US
Mailing Address - Phone:914-493-8081
Mailing Address - Fax:
Practice Address - Street 1:20 HOSPITAL OVAL W
Practice Address - Street 2:DENTAL DEPT/CEDARWOOD HALL 2ND FLOOR
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1559
Practice Address - Country:US
Practice Address - Phone:914-493-8081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055726122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist