Provider Demographics
NPI:1548415771
Name:WILBORN-HOOD, SUSAN F (DDS)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:F
Last Name:WILBORN-HOOD
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 1:3330 PIEDMONT RD.
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:404-237-5330
Mailing Address - Fax:
Practice Address - Street 1:436 TIORAM LN SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-5239
Practice Address - Country:US
Practice Address - Phone:708-825-4571
Practice Address - Fax:708-825-4571
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015339122300000X
IL019-0199451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice