Provider Demographics
NPI:1841245495
Name:CARRON, SUSAN HELEN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:HELEN
Last Name:CARRON
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:HELEN
Other - Last Name:CARRON-SIMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:40105 GRAND RIVER AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2115
Mailing Address - Country:US
Mailing Address - Phone:248-478-3232
Mailing Address - Fax:248-478-8018
Practice Address - Street 1:40105 GRAND RIVER AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2115
Practice Address - Country:US
Practice Address - Phone:248-478-3232
Practice Address - Fax:248-478-8018
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010115391223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI613152OtherUNITED CONCORDIA
MID802-825OtherBLUE CROSS BLUE SHIELD