Provider Demographics
NPI:1467507061
Name:MCBETH, SUSAN
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:MCBETH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4417 W GORE BLVD STE 11
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-5978
Mailing Address - Country:US
Mailing Address - Phone:479-366-0938
Mailing Address - Fax:
Practice Address - Street 1:500 N DIXIELAND RD
Practice Address - Street 2:SUITE 1
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3212
Practice Address - Country:US
Practice Address - Phone:479-621-8229
Practice Address - Fax:479-621-6724
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2341223X0400X
AR901223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics