Provider Demographics
NPI:1760642052
Name:STEADY, SUSAN DIANE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:DIANE
Last Name:STEADY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:POE
Other - Last Name:STEADY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:REGISTERED DENTAL HY
Mailing Address - Street 1:12320 CORRIES PLACE
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503
Mailing Address - Country:US
Mailing Address - Phone:228-523-5103
Mailing Address - Fax:228-523-4310
Practice Address - Street 1:400 VETERANS AVE
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2410
Practice Address - Country:US
Practice Address - Phone:228-523-5103
Practice Address - Fax:228-523-4310
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2351124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist