Provider Demographics
NPI:1659669927
Name:CHOU, SUSAN (DMD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:CHOU
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 1:9780 WALNUT ST STE 188
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-2350
Mailing Address - Country:US
Mailing Address - Phone:469-330-9968
Mailing Address - Fax:469-330-7800
Practice Address - Street 1:552 PEAVY RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-2188
Practice Address - Country:US
Practice Address - Phone:954-651-3936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF-27182122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist