Provider Demographics
NPI:1659656130
Name:TOWER, SUSAN PATRICIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:PATRICIA
Last Name:TOWER
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 1:21 MIDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-5349
Mailing Address - Country:US
Mailing Address - Phone:516-454-6414
Mailing Address - Fax:
Practice Address - Street 1:612 WALT WHITMAN RD
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-2102
Practice Address - Country:US
Practice Address - Phone:631-629-4490
Practice Address - Fax:631-629-4489
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049236-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice