Provider Demographics
NPI:1437252319
Name:STATTMILLER, SUSAN P (DDS, MPH)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:P
Last Name:STATTMILLER
Suffix:
Gender:F
Credentials:DDS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 DONORE SQUARE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-2181
Mailing Address - Country:US
Mailing Address - Phone:210-567-7449
Mailing Address - Fax:
Practice Address - Street 1:17 DONORE SQUARE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2181
Practice Address - Country:US
Practice Address - Phone:210-567-7449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX145741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice