Provider Demographics
NPI:1346414885
Name:TRIEMSTRA, SUZANNE P (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:P
Last Name:TRIEMSTRA
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 1:509 OLDE WATERFORD WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-4171
Mailing Address - Country:US
Mailing Address - Phone:910-383-0100
Mailing Address - Fax:910-383-0121
Practice Address - Street 1:2525 S CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2649
Practice Address - Country:US
Practice Address - Phone:269-429-1587
Practice Address - Fax:269-429-1519
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBP45537761223G0001X
NC6493122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist