Provider Demographics
NPI:1255480851
Name:MCMAHON, SUSAN M (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:MCMAHON
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 1:2643 E CARSON ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-5109
Mailing Address - Country:US
Mailing Address - Phone:412-381-3969
Mailing Address - Fax:412-381-3039
Practice Address - Street 1:2643 E CARSON ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15203-5109
Practice Address - Country:US
Practice Address - Phone:412-381-3969
Practice Address - Fax:412-381-3039
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026926L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice