Provider Demographics
NPI:1558579433
Name:WILBUR, SUZANNE M (DMD,PA)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:M
Last Name:WILBUR
Suffix:
Gender:F
Credentials:DMD,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ZEAGLER DR 420
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-3867
Mailing Address - Country:US
Mailing Address - Phone:386-325-7131
Mailing Address - Fax:386-325-7123
Practice Address - Street 1:800 ZEAGLER DR
Practice Address - Street 2:STE 420
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3883
Practice Address - Country:US
Practice Address - Phone:386-325-7131
Practice Address - Fax:386-325-7123
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00149661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice