Provider Demographics
NPI:1710566138
Name:SISLER, DAWN SUSANNE (LDH/RDH)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:SUSANNE
Last Name:SISLER
Suffix:
Gender:F
Credentials:LDH/RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:467 TOMAHAWK TRL # 1909
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-2800
Mailing Address - Country:US
Mailing Address - Phone:317-679-4073
Mailing Address - Fax:
Practice Address - Street 1:5250 E US HIGHWAY 36 STE 160
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-9078
Practice Address - Country:US
Practice Address - Phone:317-745-1680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-04
Last Update Date:2021-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902018760124Q00000X
IN13004094A124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist