Provider Demographics
NPI:1376846287
Name:CHON, SUSAN JENNY (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:JENNY
Last Name:CHON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:JENNY
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1315 W MAIN AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:TX
Mailing Address - Zip Code:78573-1643
Mailing Address - Country:US
Mailing Address - Phone:956-599-9446
Mailing Address - Fax:956-599-9449
Practice Address - Street 1:1315 W MAIN AVE STE 10
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:TX
Practice Address - Zip Code:78573-1643
Practice Address - Country:US
Practice Address - Phone:956-599-9446
Practice Address - Fax:956-599-9449
Is Sole Proprietor?:No
Enumeration Date:2010-12-15
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261631223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice