Provider Demographics
NPI:1851367544
Name:SUSMAN, STEPHANIE A (DMD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:SUSMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 E BELL RD
Mailing Address - Street 2:STE 178
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-9383
Mailing Address - Country:US
Mailing Address - Phone:602-494-3000
Mailing Address - Fax:
Practice Address - Street 1:706 E BELL RD
Practice Address - Street 2:SUITE 104
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022
Practice Address - Country:US
Practice Address - Phone:602-482-7000
Practice Address - Fax:602-787-1578
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD61511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice