Provider Demographics
NPI:1770035289
Name:CHA, SUSAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:CHA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10221 198TH ST E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-8038
Mailing Address - Country:US
Mailing Address - Phone:253-875-2900
Mailing Address - Fax:
Practice Address - Street 1:10221 198TH ST E
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-8038
Practice Address - Country:US
Practice Address - Phone:253-875-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE606827961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice