Provider Demographics
NPI:1487665543
Name:ANDO, SUSAN G (DDS)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:G
Last Name:ANDO
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 1:14991 E HAMPDEN AVE
Mailing Address - Street 2:#390
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014
Mailing Address - Country:US
Mailing Address - Phone:303-690-6662
Mailing Address - Fax:303-690-9699
Practice Address - Street 1:14991 E HAMPDEN AVE
Practice Address - Street 2:#390
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014
Practice Address - Country:US
Practice Address - Phone:303-690-6662
Practice Address - Fax:303-690-9699
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO51781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice