Provider Demographics
NPI:1477678472
Name:PARISI, SUE ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUE
Middle Name:ANN
Last Name:PARISI
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 1:60 W BIG BEAVER RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-3909
Mailing Address - Country:US
Mailing Address - Phone:248-646-7832
Mailing Address - Fax:248-646-2447
Practice Address - Street 1:60 W BIG BEAVER RD
Practice Address - Street 2:SUITE 140
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-3909
Practice Address - Country:US
Practice Address - Phone:248-646-7832
Practice Address - Fax:248-646-2447
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010184001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice