Provider Demographics
NPI:1760524169
Name:SEMAIN-OLES, SUSAN KATHRYN (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:KATHRYN
Last Name:SEMAIN-OLES
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 1:4423 E MOONLIGHT WAY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-2838
Mailing Address - Country:US
Mailing Address - Phone:480-951-4264
Mailing Address - Fax:480-951-2409
Practice Address - Street 1:4350 E CAMELBACK RD
Practice Address - Street 2:G-150
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2701
Practice Address - Country:US
Practice Address - Phone:602-840-2190
Practice Address - Fax:602-808-0820
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD328231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice