Provider Demographics
NPI:1851579668
Name:DAVID A. SUSKO DDS, AND ASSOC. P.C.
Entity Type:Organization
Organization Name:DAVID A. SUSKO DDS, AND ASSOC. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:SUSKO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-247-0262
Mailing Address - Street 1:43055 HAYES RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-2352
Mailing Address - Country:US
Mailing Address - Phone:586-247-0262
Mailing Address - Fax:586-247-6013
Practice Address - Street 1:43055 HAYES RD
Practice Address - Street 2:
Practice Address - City:STERLING HTS
Practice Address - State:MI
Practice Address - Zip Code:48313-2352
Practice Address - Country:US
Practice Address - Phone:586-247-0262
Practice Address - Fax:586-247-6013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI150741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty