Provider Demographics
NPI:1023139532
Name:SALES, SUSAN E (DDS)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:E
Last Name:SALES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 SNEATH LN
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-2308
Mailing Address - Country:US
Mailing Address - Phone:650-871-2741
Mailing Address - Fax:650-871-2781
Practice Address - Street 1:1001 SNEATH LN
Practice Address - Street 2:SUITE 108
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-2308
Practice Address - Country:US
Practice Address - Phone:650-871-2741
Practice Address - Fax:650-871-2781
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA397361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice