Provider Demographics
NPI:1659751113
Name:NEWKIRK, SUZANNE (RDH)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:NEWKIRK
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 156
Mailing Address - Street 2:
Mailing Address - City:LAKEMONT
Mailing Address - State:GA
Mailing Address - Zip Code:30552-0003
Mailing Address - Country:US
Mailing Address - Phone:425-770-0520
Mailing Address - Fax:
Practice Address - Street 1:1138 LONG LAUREL RIDGE DR
Practice Address - Street 2:
Practice Address - City:LAKEMONT
Practice Address - State:GA
Practice Address - Zip Code:30552-2968
Practice Address - Country:US
Practice Address - Phone:425-770-0520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-31
Last Update Date:2015-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00004670124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist