Provider Demographics
NPI:1598800641
Name:HENDRIX, SUZANNE SETHONE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:SETHONE
Last Name:HENDRIX
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 1:4887 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:MOUND
Mailing Address - State:MN
Mailing Address - Zip Code:55364-2005
Mailing Address - Country:US
Mailing Address - Phone:952-486-2951
Mailing Address - Fax:
Practice Address - Street 1:1005 E HART BLVD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362
Practice Address - Country:US
Practice Address - Phone:763-295-5177
Practice Address - Fax:763-295-6165
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND121521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice