Provider Demographics
NPI:1578620357
Name:SUZANNE DEGNEN DMD PC
Entity Type:Organization
Organization Name:SUZANNE DEGNEN DMD PC
Other - Org Name:SUNSET TOWER FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:DEGNEN
Authorized Official - Last Name:DEPENALOZA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:314-849-5600
Mailing Address - Street 1:11870 GRAVOIS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1800
Mailing Address - Country:US
Mailing Address - Phone:314-849-5600
Mailing Address - Fax:314-849-1139
Practice Address - Street 1:11870 GRAVOIS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1800
Practice Address - Country:US
Practice Address - Phone:314-849-5600
Practice Address - Fax:314-849-1139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0147341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty