Provider Demographics
NPI:1386184984
Name:GORMAN, SUSAN (RDH)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:GORMAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 GRAND LELY DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34113-1753
Mailing Address - Country:US
Mailing Address - Phone:239-775-3052
Mailing Address - Fax:239-775-7032
Practice Address - Street 1:7505 GRAND LELY DR
Practice Address - Street 2:NCEF PEDIATRIC DENTAL CENTER BUILDING L
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-1753
Practice Address - Country:US
Practice Address - Phone:239-775-3052
Practice Address - Fax:239-775-7032
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH 23868124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist