Provider Demographics
NPI:1689908766
Name:FOHL, SUZANNE ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:ELIZABETH
Last Name:FOHL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 WEST PATRICK STREET
Mailing Address - Street 2:FREDERICK COSMETIC & FAMILY DENTISTRY
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701
Mailing Address - Country:US
Mailing Address - Phone:301-698-8200
Mailing Address - Fax:301-698-8201
Practice Address - Street 1:337 WEST PATRICK STREET
Practice Address - Street 2:FREDERICK COSMETIC & FAMILY DENTISTRY
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701
Practice Address - Country:US
Practice Address - Phone:301-698-8200
Practice Address - Fax:301-698-8201
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD115311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice