Provider Demographics
NPI:1245234707
Name:CICHOWSKI, SUE ELLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUE
Middle Name:ELLEN
Last Name:CICHOWSKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 W WEBSTER RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-3700
Mailing Address - Country:US
Mailing Address - Phone:248-399-8100
Mailing Address - Fax:248-399-8286
Practice Address - Street 1:2711 W WEBSTER RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-3700
Practice Address - Country:US
Practice Address - Phone:248-399-8100
Practice Address - Fax:248-399-8286
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI13595122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist