Provider Demographics
NPI:1679636971
Name:MCGURK, SUZANNE K (DDS)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:K
Last Name:MCGURK
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 1:12501 CANTRELL ROAD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223
Mailing Address - Country:US
Mailing Address - Phone:501-223-3838
Mailing Address - Fax:501-223-2554
Practice Address - Street 1:12501 CANTRELL ROAD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223
Practice Address - Country:US
Practice Address - Phone:501-223-3838
Practice Address - Fax:501-223-2554
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR34001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1416472OtherUNITED CONCORDIA
AR5F438OtherBCBS OF AR
AR3400OtherDELTA DENTAL OF AR
AR5X091OtherBCBS OF AR