Provider Demographics
NPI:1508318304
Name:GUEST, SUSAN SANDSTROM (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:SANDSTROM
Last Name:GUEST
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:42287 CHERRY HILL RD STE A
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1976
Mailing Address - Country:US
Mailing Address - Phone:734-981-2444
Mailing Address - Fax:734-981-5645
Practice Address - Street 1:42287 CHERRY HILL RD STE A
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-1976
Practice Address - Country:US
Practice Address - Phone:734-981-2444
Practice Address - Fax:734-981-5645
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010190851223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics