Provider Demographics
NPI:1275962599
Name:THENUS, SUSANNY (DMD)
Entity Type:Individual
Prefix:
First Name:SUSANNY
Middle Name:
Last Name:THENUS
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 1:33454 HAVLIK DR
Mailing Address - Street 2:
Mailing Address - City:SCAPPOOSE
Mailing Address - State:OR
Mailing Address - Zip Code:97056-3836
Mailing Address - Country:US
Mailing Address - Phone:503-543-3136
Mailing Address - Fax:
Practice Address - Street 1:33454 HAVLIK DR
Practice Address - Street 2:
Practice Address - City:SCAPPOOSE
Practice Address - State:OR
Practice Address - Zip Code:97056-3836
Practice Address - Country:US
Practice Address - Phone:503-543-3136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD98921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice