Provider Demographics
NPI:1407932593
Name:MALONE, SUSAN JOY-SCHLATER (DDS, PC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:JOY-SCHLATER
Last Name:MALONE
Suffix:
Gender:F
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 STATE ST
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2785
Mailing Address - Country:US
Mailing Address - Phone:231-347-6932
Mailing Address - Fax:231-347-0292
Practice Address - Street 1:231 STATE ST
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2785
Practice Address - Country:US
Practice Address - Phone:231-347-6932
Practice Address - Fax:231-347-0292
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI139521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice