Provider Demographics
NPI:1497984124
Name:CLEARY, SUZANNE ELIZABETH (RDH)
Entity Type:Individual
Prefix:MISS
First Name:SUZANNE
Middle Name:ELIZABETH
Last Name:CLEARY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 W WARNER RD # 101-203
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-7269
Mailing Address - Country:US
Mailing Address - Phone:480-202-7049
Mailing Address - Fax:
Practice Address - Street 1:5270 W BASELINE RD STE 130
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-6959
Practice Address - Country:US
Practice Address - Phone:602-237-8182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH4963124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist