Provider Demographics
NPI:1700214657
Name:FJARLI, SUZANNE M II (DDS)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:M
Last Name:FJARLI
Suffix:II
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1421 GUERNEVILLE RD
Mailing Address - Street 2:STE 102
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-7220
Mailing Address - Country:US
Mailing Address - Phone:707-528-7000
Mailing Address - Fax:707-528-2214
Practice Address - Street 1:9800 S LA CIENEGA BLVD
Practice Address - Street 2:STE 899, RM 1
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4440
Practice Address - Country:US
Practice Address - Phone:360-449-5711
Practice Address - Fax:877-725-7443
Is Sole Proprietor?:No
Enumeration Date:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA518791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice