Provider Demographics
NPI:1821611625
Name:HUSER, JANNAYE SUSANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JANNAYE
Middle Name:SUSANNE
Last Name:HUSER
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 1:4109 LAHMEYER RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-5666
Mailing Address - Country:US
Mailing Address - Phone:260-486-3100
Mailing Address - Fax:
Practice Address - Street 1:4109 LAHMEYER RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-5666
Practice Address - Country:US
Practice Address - Phone:260-235-2992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013353A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice