Provider Demographics
NPI:1407821762
Name:KINNEAR-ADAMS, SUZANNE L (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:L
Last Name:KINNEAR-ADAMS
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 1:201 W 8TH ST
Mailing Address - Street 2:SUITE 810
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-3038
Mailing Address - Country:US
Mailing Address - Phone:719-562-4447
Mailing Address - Fax:719-583-1801
Practice Address - Street 1:6035 RIVERS AVE STE A
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-5018
Practice Address - Country:US
Practice Address - Phone:843-572-9909
Practice Address - Fax:719-583-1801
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030879L122300000X
SC71141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist