Provider Demographics
NPI:1023114451
Name:CASH, SUSAN ELAYNE (DMD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ELAYNE
Last Name:CASH
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:PO BOX 436
Mailing Address - Street 2:111 CROSS ST
Mailing Address - City:ALBANY
Mailing Address - State:KY
Mailing Address - Zip Code:42602
Mailing Address - Country:US
Mailing Address - Phone:606-387-8339
Mailing Address - Fax:606-387-8339
Practice Address - Street 1:111 CROSS ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:KY
Practice Address - Zip Code:42602
Practice Address - Country:US
Practice Address - Phone:606-387-8339
Practice Address - Fax:606-387-8339
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5736122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60057361Medicaid