Provider Demographics
NPI:1255481248
Name:LUFT-MARCOTTE, SUSAN LOUISE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LOUISE
Last Name:LUFT-MARCOTTE
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 1:3674 SHALLOW BROOK DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-1449
Mailing Address - Country:US
Mailing Address - Phone:248-426-0077
Mailing Address - Fax:248-426-9316
Practice Address - Street 1:30903 WEST TEN MILE RD.
Practice Address - Street 2:SUITE A
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-2609
Practice Address - Country:US
Practice Address - Phone:248-426-0077
Practice Address - Fax:248-426-9316
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010169441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice