Provider Demographics
NPI:1659411155
Name:SOUFFRONT, SUSAN JENNIFER (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:JENNIFER
Last Name:SOUFFRONT
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 1:4963 E STATE ROAD 64
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-5530
Mailing Address - Country:US
Mailing Address - Phone:941-747-7135
Mailing Address - Fax:941-747-7165
Practice Address - Street 1:4963 E STATE ROAD 64
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-5530
Practice Address - Country:US
Practice Address - Phone:941-747-7135
Practice Address - Fax:941-747-7165
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 138221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice