Provider Demographics
NPI:1346238300
Name:SUSMAN, MARC L (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:L
Last Name:SUSMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 N YORK ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-3863
Mailing Address - Country:US
Mailing Address - Phone:918-683-8844
Mailing Address - Fax:918-683-3399
Practice Address - Street 1:810 N YORK ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-3863
Practice Address - Country:US
Practice Address - Phone:918-683-8844
Practice Address - Fax:918-683-3399
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK47741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice