Provider Demographics
NPI:1619418662
Name:CRENSHAW, SUZANNE (RDH)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:CRENSHAW
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10841 LITTLE RD
Mailing Address - Street 2:BLDG A
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34654-2513
Mailing Address - Country:US
Mailing Address - Phone:727-619-0285
Mailing Address - Fax:727-861-4873
Practice Address - Street 1:10841 LITTLE RD
Practice Address - Street 2:BLDG A
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34654-2513
Practice Address - Country:US
Practice Address - Phone:727-619-0285
Practice Address - Fax:727-861-4873
Is Sole Proprietor?:No
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH21192124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist