Provider Demographics
NPI:1558740845
Name:SUSEK, LAUREN ELIZABETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:ELIZABETH
Last Name:SUSEK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 S. RIVER STREET
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:PA
Mailing Address - Zip Code:18705-1191
Mailing Address - Country:US
Mailing Address - Phone:570-829-1009
Mailing Address - Fax:570-829-1066
Practice Address - Street 1:270 S. RIVER STREET
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:PA
Practice Address - Zip Code:18705-1191
Practice Address - Country:US
Practice Address - Phone:570-829-1009
Practice Address - Fax:570-829-1066
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-20
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0403521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103125736-0001Medicaid