Provider Demographics
NPI:1649602228
Name:COUZENS, SUSAN HALE (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:HALE
Last Name:COUZENS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 WHIRLAWAY DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-9036
Mailing Address - Country:US
Mailing Address - Phone:859-236-4304
Mailing Address - Fax:859-236-1156
Practice Address - Street 1:435 WHIRLAWAY DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422
Practice Address - Country:US
Practice Address - Phone:859-236-4304
Practice Address - Fax:859-236-1156
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7025332B00000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7025OtherKENTUCKY DENTAL LICENSE