Provider Demographics
NPI:1760481436
Name:WHALEN, SUSANNE URSUALA (DMD)
Entity Type:Individual
Prefix:MRS
First Name:SUSANNE
Middle Name:URSUALA
Last Name:WHALEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-2746
Mailing Address - Country:US
Mailing Address - Phone:530-527-2865
Mailing Address - Fax:530-527-2408
Practice Address - Street 1:1023 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-2746
Practice Address - Country:US
Practice Address - Phone:530-527-2865
Practice Address - Fax:530-527-2408
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA451481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice