Provider Demographics
NPI:1306952643
Name:SUZANNE R MEGENITY DDS PS
Entity type:Organization
Organization Name:SUZANNE R MEGENITY DDS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MEGENITY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-423-4313
Mailing Address - Street 1:1801 1ST AVENUE SUITE 2A
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632
Mailing Address - Country:US
Mailing Address - Phone:360-423-4313
Mailing Address - Fax:360-425-1965
Practice Address - Street 1:1801 1ST AVENUE SUITE 2A
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632
Practice Address - Country:US
Practice Address - Phone:360-423-4313
Practice Address - Fax:360-425-1965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000053561223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty