Provider Demographics
NPI:1104084235
Name:ALEXANDER, SUSAN PATRICIA (DMD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:PATRICIA
Last Name:ALEXANDER
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 1:3020 ROSWELL RD STE 130
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-4987
Mailing Address - Country:US
Mailing Address - Phone:770-509-2310
Mailing Address - Fax:770-993-5987
Practice Address - Street 1:3020 ROSWELL RD STE 130
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-4987
Practice Address - Country:US
Practice Address - Phone:770-509-2310
Practice Address - Fax:770-993-5987
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0102951223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics