Provider Demographics
NPI:1235348657
Name:ZERRAHN, SUSAN LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LYNN
Last Name:ZERRAHN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 343
Mailing Address - Street 2:2993 MAIN ST., STE. #2
Mailing Address - City:PERU
Mailing Address - State:NY
Mailing Address - Zip Code:12972-0343
Mailing Address - Country:US
Mailing Address - Phone:518-643-8080
Mailing Address - Fax:518-643-8484
Practice Address - Street 1:2993 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:PERU
Practice Address - State:NY
Practice Address - Zip Code:12972-0343
Practice Address - Country:US
Practice Address - Phone:518-643-8080
Practice Address - Fax:518-643-8484
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0528721223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics