Provider Demographics
NPI:1235394883
Name:AWN, SUSAN V (DMD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:V
Last Name:AWN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 ROUTE 23
Mailing Address - Street 2:
Mailing Address - City:NEWFOUNDLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07435-1436
Mailing Address - Country:US
Mailing Address - Phone:973-697-8900
Mailing Address - Fax:
Practice Address - Street 1:2950 ROUTE 23
Practice Address - Street 2:
Practice Address - City:NEWFOUNDLAND
Practice Address - State:NJ
Practice Address - Zip Code:07435-1436
Practice Address - Country:US
Practice Address - Phone:973-697-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02252200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist