Provider Demographics
NPI:1801222344
Name:CANE, SUSAN (DDS, MA, BS)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:CANE
Suffix:
Gender:F
Credentials:DDS, MA, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11771 MONTANA AVE
Mailing Address - Street 2:#212
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-6716
Mailing Address - Country:US
Mailing Address - Phone:818-926-2036
Mailing Address - Fax:
Practice Address - Street 1:11771 MONTANA AVE
Practice Address - Street 2:#212
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-6716
Practice Address - Country:US
Practice Address - Phone:818-926-2036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA625451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice