Provider Demographics
NPI:1023177359
Name:SUSEK, ALBIN F (DDS)
Entity type:Individual
Prefix:DR
First Name:ALBIN
Middle Name:F
Last Name:SUSEK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 WEST ST MARY'S ROAD
Mailing Address - Street 2:
Mailing Address - City:WILKES-BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18706
Mailing Address - Country:US
Mailing Address - Phone:570-822-3746
Mailing Address - Fax:570-522-3746
Practice Address - Street 1:93 WEST ST MARY'S ROAD
Practice Address - Street 2:
Practice Address - City:WILKES-BARRE
Practice Address - State:PA
Practice Address - Zip Code:18706
Practice Address - Country:US
Practice Address - Phone:570-822-3746
Practice Address - Fax:570-522-3746
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAD019274-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice