Provider Demographics
NPI:1649588468
Name:DWYER, SUSAN LYNN (BS RDH)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LYNN
Last Name:DWYER
Suffix:
Gender:F
Credentials:BS RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 N LINCOLN AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-4877
Mailing Address - Country:US
Mailing Address - Phone:970-622-0970
Mailing Address - Fax:
Practice Address - Street 1:1135 N LINCOLN AVE STE 4
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-4877
Practice Address - Country:US
Practice Address - Phone:970-622-0970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO903672124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist