Provider Demographics
NPI:1649218231
Name:DULLARD, SUANNE MARIE (DDS)
Entity Type:Individual
Prefix:MS
First Name:SUANNE
Middle Name:MARIE
Last Name:DULLARD
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 1:56184 FARM CAMP RD
Mailing Address - Street 2:
Mailing Address - City:BIGFORK
Mailing Address - State:MN
Mailing Address - Zip Code:56628-4251
Mailing Address - Country:US
Mailing Address - Phone:218-743-3202
Mailing Address - Fax:
Practice Address - Street 1:100 PINETREE DR
Practice Address - Street 2:
Practice Address - City:BIGFORK
Practice Address - State:MN
Practice Address - Zip Code:56628
Practice Address - Country:US
Practice Address - Phone:218-743-3707
Practice Address - Fax:218-743-4218
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9965122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist