Provider Demographics
NPI:1477688653
Name:SUSI, LOUIS W (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:W
Last Name:SUSI
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7334 E. BROAD STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004
Mailing Address - Country:US
Mailing Address - Phone:614-487-8016
Mailing Address - Fax:
Practice Address - Street 1:7334 E BROAD ST
Practice Address - Street 2:SUITE C
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-9239
Practice Address - Country:US
Practice Address - Phone:614-577-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH218261223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics