Provider Demographics
NPI:1326125915
Name:FRANCIS, SUSAN GEHM (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:GEHM
Last Name:FRANCIS
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 1:3200 BELLMEAD DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76705-3077
Mailing Address - Country:US
Mailing Address - Phone:254-799-4000
Mailing Address - Fax:254-799-4035
Practice Address - Street 1:3200 BELLMEAD DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76705-3077
Practice Address - Country:US
Practice Address - Phone:254-799-4000
Practice Address - Fax:254-799-4035
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX192531223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB19253-01OtherCHIPS
TX01365431OtherUCCI (UNITED CONCORDIA)