Provider Demographics
NPI:1508829771
Name:CLEEREMAN, SUSAN JEAN (DDS)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:JEAN
Last Name:CLEEREMAN
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 1:22644 NONA ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-4711
Mailing Address - Country:US
Mailing Address - Phone:313-656-3573
Mailing Address - Fax:
Practice Address - Street 1:15238 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2933
Practice Address - Country:US
Practice Address - Phone:313-581-0684
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010143901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1958212070OtherBLUE CROSS MEDICAL ID#
MI2721984Medicaid