Provider Demographics
NPI:1851575609
Name:LUKEN, SUZANNE R (RDH)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:R
Last Name:LUKEN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12279 BRADY DR
Mailing Address - Street 2:
Mailing Address - City:CUSTER
Mailing Address - State:SD
Mailing Address - Zip Code:57730-9160
Mailing Address - Country:US
Mailing Address - Phone:605-673-2521
Mailing Address - Fax:
Practice Address - Street 1:12279 BRADY DR
Practice Address - Street 2:
Practice Address - City:CUSTER
Practice Address - State:SD
Practice Address - Zip Code:57730-9160
Practice Address - Country:US
Practice Address - Phone:605-673-2521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD750124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist